Provider Demographics
NPI:1124824750
Name:BERRY-BEDELL, JOANN ELEANORE (RPH)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:ELEANORE
Last Name:BERRY-BEDELL
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:E
Other - Last Name:WILCZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 W COUNTY HIGHWAY 30A UNIT M1-106
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-0187
Mailing Address - Country:US
Mailing Address - Phone:850-622-3313
Mailing Address - Fax:
Practice Address - Street 1:2050 W COUNTY HIGHWAY 30A UNIT M1-106
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-0187
Practice Address - Country:US
Practice Address - Phone:850-622-3313
Practice Address - Fax:850-622-3255
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist