Provider Demographics
NPI:1083287775
Name:BEDDOE, SOPHIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:BEDDOE
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 1:1320 FILLMORE AVE UNIT 110
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5883
Mailing Address - Country:US
Mailing Address - Phone:228-342-8579
Mailing Address - Fax:
Practice Address - Street 1:1300 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5802
Practice Address - Country:US
Practice Address - Phone:704-910-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist