MEDICARE: DR. AUSTIN WEAVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26025489A	IN

General Provider Information

NPI Number	:	1538551536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN WEAVER

Provider Business Mailing Address
First Line	:	6269 W 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-2928
Country	:	US
Telephone Number	:	317-293-8640
Fax Number	:	317-293-8728

Provider Business Practice Location Address
First Line	:	6269 W 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-2928
Country	:	US
Telephone Number	:	317-293-8640
Fax Number	:	317-293-8728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2015
Last Update Date	:	02/27/2015

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Directions to “ DR. AUSTIN WEAVER ” Practice Location

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