Healthcare Provider Details

I. General information

NPI: 1730851270
Provider Name (Legal Business Name): ANNA KATHRYN WEATHERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 HIGHWAY 45 N
COLUMBUS MS
39705-2118
US

IV. Provider business mailing address

309 HOLLY CV
COLUMBUS MS
39705-1747
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-0747
  • Fax:
Mailing address:
  • Phone: 662-251-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE-100415
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: