Provider Demographics
NPI:1316922172
Name:WEYRAUCH, JOHN ADAM IV (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ADAM
Last Name:WEYRAUCH
Suffix:IV
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 1:12756 BAIR RD
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9633
Mailing Address - Country:US
Mailing Address - Phone:330-683-1142
Mailing Address - Fax:330-857-1731
Practice Address - Street 1:4959 KIDRON RD
Practice Address - Street 2:
Practice Address - City:KIDRON
Practice Address - State:OH
Practice Address - Zip Code:44636-0231
Practice Address - Country:US
Practice Address - Phone:330-857-0115
Practice Address - Fax:330-857-1731
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist