Provider Demographics
NPI:1780977025
Name:WEAVER, ELIZABETH R
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
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 1:10517 TREDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1160
Mailing Address - Country:US
Mailing Address - Phone:919-676-7223
Mailing Address - Fax:
Practice Address - Street 1:9600 FALLS OF NEUSE RD
Practice Address - Street 2:HARRIS TEETER PHARMACY
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2468
Practice Address - Country:US
Practice Address - Phone:919-845-0613
Practice Address - Fax:919-846-5369
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist