Provider Demographics
NPI:1972840593
Name:BEVIS, THOMAS ANDERSON
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDERSON
Last Name:BEVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 CAP CIR SW
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305
Mailing Address - Country:US
Mailing Address - Phone:850-878-1740
Mailing Address - Fax:
Practice Address - Street 1:5032 CAP CIR SW
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305
Practice Address - Country:US
Practice Address - Phone:850-878-1740
Practice Address - Fax:
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
FLPS36754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist