Provider Demographics
NPI:1740952613
Name:WEAVER, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31990 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2181
Mailing Address - Country:US
Mailing Address - Phone:440-933-9598
Mailing Address - Fax:440-933-7571
Practice Address - Street 1:31990 WALKER RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2181
Practice Address - Country:US
Practice Address - Phone:440-933-9598
Practice Address - Fax:440-933-7571
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist