Healthcare Provider Details

I. General information

NPI: 1346974839
Provider Name (Legal Business Name): WEAVE DR APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 SUPERIOR LN STE A21
BOWIE MD
20715-1934
US

IV. Provider business mailing address

12138 CENTRAL AVE # 221
BOWIE MD
20721-1910
US

V. Phone/Fax

Practice location:
  • Phone: 703-973-7146
  • Fax: 240-245-2102
Mailing address:
  • Phone: 703-973-7146
  • Fax: 240-245-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA MITCHELL
Title or Position: OWNER
Credential:
Phone: 703-973-7146