Provider Demographics
NPI:1932703139
Name:KERVIN, JOANNE AUGUSTA (RPH)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:AUGUSTA
Last Name:KERVIN
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 1:4351 WHEATLAND WAY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2662
Mailing Address - Country:US
Mailing Address - Phone:727-515-7398
Mailing Address - Fax:
Practice Address - Street 1:30387 US 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1053
Practice Address - Country:US
Practice Address - Phone:727-781-2955
Practice Address - Fax:727-781-2965
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist