Provider Demographics
NPI:1609114297
Name:MYERS, MARY BETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:MYERS
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 1:1971 SR 60 E
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3603
Mailing Address - Country:US
Mailing Address - Phone:813-684-3694
Mailing Address - Fax:813-684-3961
Practice Address - Street 1:1971 SR 60 E
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3603
Practice Address - Country:US
Practice Address - Phone:813-684-3694
Practice Address - Fax:813-684-3961
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist