Provider Demographics
NPI:1881932556
Name:DIAL, BETH ANN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:DIAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982
Mailing Address - Country:US
Mailing Address - Phone:772-467-2188
Mailing Address - Fax:772-467-2189
Practice Address - Street 1:2517 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5922
Practice Address - Country:US
Practice Address - Phone:772-467-2188
Practice Address - Fax:772-467-2189
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist