Provider Demographics
NPI:1295310597
Name:WOMBLE, BEVERLY DOUGLAS (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DOUGLAS
Last Name:WOMBLE
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 1:1404 LANDOVER PL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8498
Mailing Address - Country:US
Mailing Address - Phone:850-284-5330
Mailing Address - Fax:
Practice Address - Street 1:3221 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-2821
Practice Address - Country:US
Practice Address - Phone:850-562-2829
Practice Address - Fax:850-562-1097
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist