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General NPI Number Information
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NPI Number | 1124508783
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Entity Type | Individual
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Provider Name | MICHELLE WEAVER
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 3825 E BAY DR
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City | LARGO
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State | FL
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Zip | 33771-1936
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Country | US
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Telephone | 727-538-8718
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Fax |
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Provider Business Mailing Address
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Address Line | 601 ROSERY RD NE APT 3406
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City | LARGO
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State | FL
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Zip | 33770-3824
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Country | US
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Telephone | 813-810-9456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS58100
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License Number State | FL
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