Healthcare Provider Details

I. General information

NPI: 1780712166
Provider Name (Legal Business Name): DAVID R WEBER R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALLACE WAY
GRANDVIEW WA
98930-8805
US

IV. Provider business mailing address

1000 WALLACE WAY
GRANDVIEW WA
98930-8805
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-3444
  • Fax:
Mailing address:
  • Phone: 509-882-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051 031334
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61011531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: