MEDICARE: MS. MARYANN WEAVER R.PH.

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	26279	TX

General Provider Information

NPI Number	:	1902111974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARYANN WEAVER R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 667
Second Line	:
City	:	BLANCO
State	:	TX
Zip	:	78606-0667
Country	:	US
Telephone Number	:	512-585-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	20475 HWY 46 W
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6146
Country	:	US
Telephone Number	:	830-438-4027
Fax Number	:

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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