Healthcare Provider Details

I. General information

NPI: 1336238468
Provider Name (Legal Business Name): MARIE MAY BEADLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE MAY DERVAN PHARMD

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21281 GRAYTON TER
PORT CHARLOTTE FL
33954-3109
US

IV. Provider business mailing address

2649 LEAR ROAD
ENGLEWOOD FL
34224
US

V. Phone/Fax

Practice location:
  • Phone: 941-613-0919
  • Fax:
Mailing address:
  • Phone: 941-323-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS38788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: