Provider Demographics
NPI:1336238468
Name:BEADLE, MARIE MAY (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:MAY
Last Name:BEADLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:MAY
Other - Last Name:DERVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2649 LEAR ROAD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224
Mailing Address - Country:US
Mailing Address - Phone:941-323-3262
Mailing Address - Fax:
Practice Address - Street 1:21281 GRAYTON TER
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3109
Practice Address - Country:US
Practice Address - Phone:941-613-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS387881835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric