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General NPI Number Information
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NPI Number | 1295310597
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Entity Type | Individual
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Provider Name | BEVERLY DOUGLAS WOMBLE PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 3221 N MONROE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32303-2821
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Country | US
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Telephone | 850-562-2829
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Fax | 850-562-1097
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Provider Business Mailing Address
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Address Line | 1404 LANDOVER PL
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City | TALLAHASSEE
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State | FL
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Zip | 32317-8498
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Country | US
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Telephone | 850-284-5330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS18798
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License Number State | FL
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