Provider Demographics
NPI:1952912032
Name:BELL, TYRISSA VICTORIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYRISSA
Middle Name:VICTORIA
Last Name:BELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TYRISSA
Other - Middle Name:VICTORIA
Other - Last Name:LAWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:14405 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-223-5017
Mailing Address - Fax:904-223-6631
Practice Address - Street 1:14405 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-223-5017
Practice Address - Fax:904-223-6631
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist