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General NPI Number Information
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NPI Number | 1629136460
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Entity Type | Organization
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Legal Business Name | WOODY WEAVER PHARMACY
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2722 WEST GENTRY PARKWAY
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City | TYLER
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State | TX
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Zip | 75702
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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 | 2722 WEST GENTRY PARKWAY
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City | TYLER
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State | TX
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Zip | 75702
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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 | MR. WOODROW VERNON WEAVER
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Credential | RPH
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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