Healthcare Provider Details

I. General information

NPI: 1235687724
Provider Name (Legal Business Name): DIANE WEAKLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 HANOVER AVE APT 1
RICHMOND VA
23220-3549
US

IV. Provider business mailing address

1723 HANOVER AVE APT 1
RICHMOND VA
23220-3549
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-2339
  • Fax:
Mailing address:
  • Phone: 804-358-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number0202004608
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: