Provider Demographics
NPI:1871890640
Name:WEILER, BRENDA DIANE (RPH)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:DIANE
Last Name:WEILER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2157
Mailing Address - Country:US
Mailing Address - Phone:828-855-3125
Mailing Address - Fax:
Practice Address - Street 1:102 ROCK BARN RD NE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9727
Practice Address - Country:US
Practice Address - Phone:828-465-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist