Provider Demographics
NPI:1902111974
Name:WEAVER, MARYANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0667
Mailing Address - Country:US
Mailing Address - Phone:512-585-6510
Mailing Address - Fax:
Practice Address - Street 1:20475 HWY 46 W
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6146
Practice Address - Country:US
Practice Address - Phone:830-438-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist