Healthcare Provider Details

I. General information

NPI: 1659615029
Provider Name (Legal Business Name): KERRI DIANE BEVACQUA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRI BEVACQUA

II. Dates (important events)

Enumeration Date: 11/24/2012
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 SHELTER COVE LN
HILTON HEAD ISLAND SC
29928-3543
US

IV. Provider business mailing address

42 SHELTER COVE LN
HILTON HEAD ISLAND SC
29928-3543
US

V. Phone/Fax

Practice location:
  • Phone: 843-852-0550
  • Fax:
Mailing address:
  • Phone: 843-842-0550
  • Fax: 843-842-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10521
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: