MEDICARE: PAULA K WEAVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	44225	MO

General Provider Information

NPI Number	:	1205872595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA K WEAVER

Provider Business Mailing Address
First Line	:	5465 GOETHE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 CHIPPEWA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2355
Country	:	US
Telephone Number	:	314-352-5201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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Directions to “ PAULA K WEAVER ” Practice Location

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