Provider Demographics
NPI:1427235043
Name:WEYRAUCH, JOHN ADAM V (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADAM
Last Name:WEYRAUCH
Suffix:V
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 S MAIN ST
Mailing Address - Street 2:KROGER PHARMACY
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3840
Mailing Address - Country:US
Mailing Address - Phone:937-439-6420
Mailing Address - Fax:937-439-6420
Practice Address - Street 1:1095 S MAIN ST
Practice Address - Street 2:KROGER PHARMACY
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3840
Practice Address - Country:US
Practice Address - Phone:937-439-6420
Practice Address - Fax:937-439-6420
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist