MEDICARE: WEAVER PHARMACY INC

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	3336C0004X	Compounding Pharmacy
2	3336S0011X	Specialty Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	PH20021	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1004162	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689715427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEAVER PHARMACY INC

Provider Business Mailing Address
First Line	:	1866 N TAMIAMI TRL
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3366
Country	:	US
Telephone Number	:	239-995-2700
Fax Number	:	239-995-2707

Provider Business Practice Location Address
First Line	:	1866 N TAMIAMI TRL
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3366
Country	:	US
Telephone Number	:	239-995-2700
Fax Number	:	239-995-2707

Authorized Official
Title or Position	:	PHARM
Name	:	AHMAD ALHADDAD
Credential	:	RPH
Telephone Number	:	239-995-2700

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	01/19/2010

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Directions to “WEAVER PHARMACY INC ” Practice Location

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