Provider Demographics
NPI:1285315432
Name:SUMMERFORD, JOSEPH BRYAN (RPH)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRYAN
Last Name:SUMMERFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 ASHFORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-8996
Mailing Address - Country:US
Mailing Address - Phone:850-607-3803
Mailing Address - Fax:
Practice Address - Street 1:2237 W NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9416
Practice Address - Country:US
Practice Address - Phone:850-473-0286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist