Provider Demographics
NPI:1164183471
Name:VERNON, MARY JUDITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JUDITH
Last Name:VERNON
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 1:1300 TYNDALL DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-4062
Mailing Address - Country:US
Mailing Address - Phone:850-381-0671
Mailing Address - Fax:
Practice Address - Street 1:3621 N HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-9743
Practice Address - Country:US
Practice Address - Phone:850-914-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist