Provider Demographics
NPI:1912381054
Name:SORVILLO, BEVERLY (RPH)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SORVILLO
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 1:6810 WALDEN CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7430
Mailing Address - Country:US
Mailing Address - Phone:850-590-5885
Mailing Address - Fax:
Practice Address - Street 1:110 E PAUL RUSSELL RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-6977
Practice Address - Country:US
Practice Address - Phone:850-656-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist