MEDICARE: MR. BRADLEY STEVENSON WEAVER R.PH.

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	12708	NC

General Provider Information

NPI Number	:	1811911860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY STEVENSON WEAVER R.PH.

Provider Business Mailing Address
First Line	:	5180 WHAITLEY LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-7955
Country	:	US
Telephone Number	:	336-307-1897
Fax Number	:

Provider Business Practice Location Address
First Line	:	3738 BATTLEGROUND AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2344
Country	:	US
Telephone Number	:	336-282-3697
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/24/2023

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