Provider Demographics
NPI:1083965099
Name:TWICHELL, BEVERLY N (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:N
Last Name:TWICHELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 E BEARDSLEY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1300
Mailing Address - Country:US
Mailing Address - Phone:480-375-2878
Mailing Address - Fax:480-375-2875
Practice Address - Street 1:2450 E BEARDSLEY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-1300
Practice Address - Country:US
Practice Address - Phone:480-375-2878
Practice Address - Fax:480-375-2875
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist