Healthcare Provider Details

I. General information

NPI: 1205872595
Provider Name (Legal Business Name): PAULA K WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 CHIPPEWA ST
SAINT LOUIS MO
63109-2355
US

IV. Provider business mailing address

5465 GOETHE AVE
SAINT LOUIS MO
63109-3206
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-5201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44225
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: