Provider Demographics
NPI:1699292136
Name:WEYAND, KATELYN (PHARMD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:WEYAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BREAKERS DR UNIT 528
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4414
Mailing Address - Country:US
Mailing Address - Phone:814-520-1872
Mailing Address - Fax:
Practice Address - Street 1:10317 OCEAN HWY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6520
Practice Address - Country:US
Practice Address - Phone:843-237-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist