Provider Demographics
NPI:1982187993
Name:FEENEY, BEVERLY MICHELLE
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MICHELLE
Last Name:FEENEY
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:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:IDER
Mailing Address - State:AL
Mailing Address - Zip Code:35981-0403
Mailing Address - Country:US
Mailing Address - Phone:256-996-7513
Mailing Address - Fax:
Practice Address - Street 1:2001 GLENN BLVD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3535
Practice Address - Country:US
Practice Address - Phone:256-996-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist