Healthcare Provider Details

I. General information

NPI: 1801823968
Provider Name (Legal Business Name): MR. WILLIAM D WEAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 G ST
GENEVA NE
68361-2007
US

IV. Provider business mailing address

1014 G ST
GENEVA NE
68361-2007
US

V. Phone/Fax

Practice location:
  • Phone: 402-759-4433
  • Fax:
Mailing address:
  • Phone: 402-759-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9019
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: