WOODY WEAVER PHARMACY (NPI# 1629136460) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629136460 |
| Entity Type | Organization |
| Organization Name | WOODY WEAVER PHARMACY |
| Practice Address |
2722 West Gentry Parkway Tyler TX 75702 |
| Practice Telephone | 9035932533 |
| Practice Fax Number | 9035932555 |
| Mailing Telephone | 9035932533 |
| Mailing Fax Number | 9035932555 |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. WOODROW VERNON WEAVER (OWNER) |
| Authorized Official Telephone | 9035932533 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NABP | 4532936 | 01 | |
| DEA | AW4236611 | 01 | |
| TX | 130525 | 05 |
| Street Address |
2722 WEST GENTRY PARKWAY |
| City | TYLER |
| State | TX |
| Zip Code | 75702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679116610 | Tiffiney Mcmakin | Nurse Practitioner | 810 E Houston St # 100, Tyler, TX 75702 | 2019-10-22 |
| 1659852507 | Krystal Gayle Lilley | Licensed Vocational Nurse | 100 E Ferguson St Ste 60a, Tyler, TX 75702 | 2018-08-28 |
| 1679029383 | Cynthia Lynn Kalawe | Physical Therapist | 100 E Ferguson, Suite 1204, Tyler, TX 75702 | 2016-09-01 |
| 1649623646 | Susan E Oxford | Social Worker | 13495 Frankston Highway, Tyler, TX 75702 | 2016-07-14 |
| 1053769281 | All Kidz Kan | Home Health | 2902 E Front St, Tyler, TX 75702 | 2016-05-27 |
| 1821415639 | Heather Mullins | Physical Therapy Assistant | 100 E. Ferguson Ste.1204, Tyler, TX 75702 | 2014-03-19 |
| 1346671336 | Dennis Keith Johnson | Dentist | 3081 Hwy. 31 East, Tyler, TX 75702 | 2013-12-02 |
| 1275882201 | Bobby Gibson | Counselor | 401 East Front Street, Ste 233, Tyler, TX 75702 | 2012-09-06 |
| 1144596792 | Tina Marie Borke | Clinical Neuropsychologist | 719 West Front St., Tyler, TX 75702 | 2012-03-28 |
| 1457629529 | James Whaley Rapp | Specialist/Technologist | 430 South Beckham Avenue, Trinity Mother Frances Sports Medicine, Tyler, TX 75702 | 2011-12-05 |
| Find all providers in zip 75702 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845827 | 62 Roses Wellness, LLC | Pharmacy | 3320 Troup Hwy Ste 140, Tyler, TX 75701-8358 | 2020-06-09 |
| 1629601489 | Kvb LLC | Pharmacy | 13027 Hwy 155 S Ste 200, Tyler, TX 75703-6548 | 2020-02-19 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| 1427323005 | Pharmscript of Texas LLC | Pharmacy | 5012 Profit Dr Ste B, Tyler, TX 75707-1839 | 2012-03-15 |
| 1083910137 | Brookshire Grocery Company | Pharmacy | 6991 Old Jacksonville Hwy, Tyler, TX 75703-0579 | 2011-02-08 |
| 1003989336 | Brookshire Grocery Company | Pharmacy | 2734 E 5th St, Attention Pharmacy Dept, Tyler, TX 75701-5021 | 2006-11-16 |
| 1255404588 | Brookshire Grocery Company | Pharmacy | 3828 Troup Hwy, Attention Pharmacy Dept, Tyler, TX 75703-1726 | 2006-11-16 |
| 1790858025 | Brookshire Grocery Company | Pharmacy | 113 N Nw Loop 323, Attention Pharmacy Dept, Tyler, TX 75702-8725 | 2006-11-16 |
| 1073686309 | Brookshire Grocery Company | Pharmacy | 1105 E Gentry Pkwy, Attention Pharmacy Dept, Tyler, TX 75702-4715 | 2006-11-16 |
| 1003989575 | Brookshire Grocery Company | Pharmacy | 100 Rice Rd, Attention Pharmacy Dept, Tyler, TX 75703-3761 | 2006-11-15 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.