Healthcare Provider Details

I. General information

NPI: 1356649214
Provider Name (Legal Business Name): ROBERT ALLEN WEAVER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 INDEPENDENCE ST
PERRYOPOLIS PA
15473
US

IV. Provider business mailing address

301 INDEPENDENCE ST PO BOX 314
PERRYOPOLIS PA
15473
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-4422
  • Fax: 724-736-0715
Mailing address:
  • Phone: 724-736-4422
  • Fax: 724-736-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP026719L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: