Healthcare Provider Details

I. General information

NPI: 1699224253
Provider Name (Legal Business Name): KATHERINE TENNEY WEAVER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 PUBLIC SQ
STOCKTON MO
65785-7617
US

IV. Provider business mailing address

PO BOX 796 307 EAST OAK ST
STOCKTON MO
65785
US

V. Phone/Fax

Practice location:
  • Phone: 417-276-3128
  • Fax: 417-276-4194
Mailing address:
  • Phone: 620-757-8018
  • Fax: 417-276-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2016021936
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-100197
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: