Healthcare Provider Details

I. General information

NPI: 1649097056
Provider Name (Legal Business Name): BRIAN WEBER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 COPPERSHIRE CV N
MEMPHIS TN
38138-2046
US

IV. Provider business mailing address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 513-213-4392
  • Fax:
Mailing address:
  • Phone: 901-293-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number48198
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: