Provider Demographics
NPI:1639649866
Name:JOSE, BERYL
Entity Type:Individual
Prefix:DR
First Name:BERYL
Middle Name:
Last Name:JOSE
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 1:7717 SUNBAR LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-0206
Mailing Address - Country:US
Mailing Address - Phone:510-921-1690
Mailing Address - Fax:
Practice Address - Street 1:5771 NOLENSVILLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6423
Practice Address - Country:US
Practice Address - Phone:615-834-7041
Practice Address - Fax:618-834-8915
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist