Provider Demographics
NPI:1538553102
Name:WEAVER, MICHAEL ROY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:WEAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7663
Mailing Address - Country:US
Mailing Address - Phone:760-327-4381
Mailing Address - Fax:760-327-4388
Practice Address - Street 1:425 S SUNRISE WAY
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7663
Practice Address - Country:US
Practice Address - Phone:760-327-4381
Practice Address - Fax:760-327-4388
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-22
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist