Provider Demographics
NPI:1366328981
Name:WEAVER, BRYAN LEE (PHARMD, MBA, RPH)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:LEE
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PHARMD, MBA, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FERRIS STATE CT
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-8842
Mailing Address - Country:US
Mailing Address - Phone:440-731-2673
Mailing Address - Fax:
Practice Address - Street 1:320 MARKET DR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2887
Practice Address - Country:US
Practice Address - Phone:440-324-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03445840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist