Provider Demographics
NPI:1780690883
Name:WEAVER, TERRY HARLAN (RPH)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:HARLAN
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 1:100F W DEAN KEETON ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1006
Mailing Address - Country:US
Mailing Address - Phone:512-471-1824
Mailing Address - Fax:
Practice Address - Street 1:100F W DEAN KEETON ST
Practice Address - Street 2:1.110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1006
Practice Address - Country:US
Practice Address - Phone:512-471-1824
Practice Address - Fax:512-475-8218
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist