Provider Demographics
NPI:1477919843
Name:BEVERLY, JENA (RPH)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:BEVERLY
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 1:986 DAY RD
Mailing Address - Street 2:
Mailing Address - City:MEANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30256-2678
Mailing Address - Country:US
Mailing Address - Phone:770-468-4020
Mailing Address - Fax:
Practice Address - Street 1:986 DAY ROAD
Practice Address - Street 2:
Practice Address - City:MEANSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30256
Practice Address - Country:US
Practice Address - Phone:770-468-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist