Healthcare Provider Details

I. General information

NPI: 1942173927
Provider Name (Legal Business Name): NICOLE BREANN WEAKLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 28TH ST
BOULDER CO
80301-1440
US

IV. Provider business mailing address

11684 PECOS ST APT 304
WESTMINSTER CO
80234-3035
US

V. Phone/Fax

Practice location:
  • Phone: 303-938-9284
  • Fax:
Mailing address:
  • Phone: 719-688-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0025381
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: