MEDICARE: DIANE WEAKLEY RPH

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	1835G0303X	Geriatric Pharmacist	0202004608	VA

General Provider Information

NPI Number	:	1235687724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE WEAKLEY RPH

Provider Business Mailing Address
First Line	:	1723 HANOVER AVE APT 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-3549
Country	:	US
Telephone Number	:	804-358-2339
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 HANOVER AVE APT 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-3549
Country	:	US
Telephone Number	:	804-358-2339
Fax Number	:

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

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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