Provider Demographics
NPI:1508830035
Name:HARDISON, BEVERLY BASS (RPH)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:BASS
Last Name:HARDISON
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 1:304 HOGAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-9483
Mailing Address - Country:US
Mailing Address - Phone:252-466-0252
Mailing Address - Fax:
Practice Address - Street 1:BEAUFORT RD
Practice Address - Street 2:BLGD 4389
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:US
Practice Address - Phone:252-466-0252
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist