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General NPI Number Information
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NPI Number | 1033109053
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Entity Type | Organization
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Legal Business Name | WOODY WEAVER PHARMACY INC
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 2726 W GENTRY PKWY
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City | TYLER
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State | TX
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Zip | 75702-1635
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Country | US
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Telephone | 903-593-2533
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Fax | 903-593-2555
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Provider Business Mailing Address
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Address Line | 2726 W GENTRY PKWY
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City | TYLER
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State | TX
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Zip | 75702-1635
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Country | US
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Telephone | 903-593-2533
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Fax | 903-593-2555
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACKIE LYNN WEAVER
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Credential | PHARM D
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Telephone | 903-593-2533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1947
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License Number State | TX
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