Healthcare Provider Details

I. General information

NPI: 1720331432
Provider Name (Legal Business Name): KATHRYN WEAKLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7890-B RICHMOND-TAPPAHANNOCK HWY
AYLETT VA
23009-0029
US

IV. Provider business mailing address

PO BOX 29 7890-B RICHMOND-TAPPAHANNOCK HWY
AYLETT VA
23009-0029
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-3885
  • Fax: 804-769-4413
Mailing address:
  • Phone: 804-769-3885
  • Fax: 804-769-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: