Provider Demographics
NPI:1568671063
Name:WEBB, MEDA SMITH
Entity Type:Individual
Prefix:MRS
First Name:MEDA
Middle Name:SMITH
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SUMMER BREEZE RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-6032
Mailing Address - Country:US
Mailing Address - Phone:850-249-0199
Mailing Address - Fax:
Practice Address - Street 1:2533 THOMAS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-6252
Practice Address - Country:US
Practice Address - Phone:850-235-3200
Practice Address - Fax:850-234-2341
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist