Provider Demographics
NPI:1942231238
Name:DELOACH, BEVERLY D (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:D
Last Name:DELOACH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 WATERFORD PARK CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2727
Mailing Address - Country:US
Mailing Address - Phone:678-442-0817
Mailing Address - Fax:
Practice Address - Street 1:4301 MOW WAY ROAD
Practice Address - Street 2:
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist