Provider Demographics
NPI:1740692169
Name:WEAVER, GARY (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33397 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8298
Mailing Address - Country:US
Mailing Address - Phone:951-852-2392
Mailing Address - Fax:951-303-1495
Practice Address - Street 1:33397 BARRINGTON DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-8298
Practice Address - Country:US
Practice Address - Phone:951-852-2392
Practice Address - Fax:951-303-1495
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44646183500000X
IN26016745A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist