Healthcare Provider Details

I. General information

NPI: 1831552736
Provider Name (Legal Business Name): ASHLEY WEAVER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MAIN ST
FOUNTAIN INN SC
29644-1907
US

IV. Provider business mailing address

203 N MAIN ST
FOUNTAIN INN SC
29644-1907
US

V. Phone/Fax

Practice location:
  • Phone: 864-862-4414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36485
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: