Provider Demographics
NPI:1811911860
Name:WEAVER, BRADLEY STEVENSON (RPH)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:STEVENSON
Last Name:WEAVER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 WHAITLEY LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7955
Mailing Address - Country:US
Mailing Address - Phone:336-307-1897
Mailing Address - Fax:
Practice Address - Street 1:3738 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2344
Practice Address - Country:US
Practice Address - Phone:336-282-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist