Provider Demographics
NPI:1720331432
Name:WEAKLEY, KATHRYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WEAKLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:7890-B RICHMOND-TAPPAHANNOCK HWY
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-0029
Mailing Address - Country:US
Mailing Address - Phone:804-769-3885
Mailing Address - Fax:804-769-4413
Practice Address - Street 1:7890-B RICHMOND-TAPPAHANNOCK HWY
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-0029
Practice Address - Country:US
Practice Address - Phone:804-769-3885
Practice Address - Fax:804-769-4413
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202207978OtherVA STATE LICENSE