Provider Demographics
NPI:1942173927
Name:WEAKLEY, NICOLE BREANN (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BREANN
Last Name:WEAKLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11684 PECOS ST APT 304
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3035
Mailing Address - Country:US
Mailing Address - Phone:719-688-6528
Mailing Address - Fax:
Practice Address - Street 1:3325 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1440
Practice Address - Country:US
Practice Address - Phone:303-938-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0025381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist