Provider Demographics
NPI:1225479041
Name:BEADLE, BARBARA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BEADLE
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 1:2261 KENT ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2626
Mailing Address - Country:US
Mailing Address - Phone:321-480-9085
Mailing Address - Fax:
Practice Address - Street 1:4305 NORFOLK PKWY
Practice Address - Street 2:102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8604
Practice Address - Country:US
Practice Address - Phone:321-821-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist