# RANDOLPH J WEAVER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Village Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104282318
- **Authorized official:** RANDOLPH WEAVER (OWNER/RPH)
- **Authorized official phone:** (607) 664-9039

## Contact information

- **Practice address:** 7181 STATE ROUTE 54, BATH, NY 14810-9502
- **Practice address phone:** (607) 664-9039
- **Mailing address:** 7181 STATE ROUTE 54, BATH, NY 14810
- **Mailing address phone:** (607) 664-9039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 034106 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 01/05/2016
- **Last updated:** 01/25/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2157398 | PK | — |