Healthcare Provider Details

I. General information

NPI: 1689715427
Provider Name (Legal Business Name): WEAVER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 N TAMIAMI TRL
NORTH FORT MYERS FL
33903-3366
US

IV. Provider business mailing address

1866 N TAMIAMI TRL
NORTH FORT MYERS FL
33903-3366
US

V. Phone/Fax

Practice location:
  • Phone: 239-995-2700
  • Fax: 239-995-2707
Mailing address:
  • Phone: 239-995-2700
  • Fax: 239-995-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH20021
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AHMAD ALHADDAD
Title or Position: PHARM
Credential: RPH
Phone: 239-995-2700