Provider Demographics
NPI:1366711541
Name:WRIGHT, JOHN BERNARD SR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BERNARD
Last Name:WRIGHT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7320
Mailing Address - Country:US
Mailing Address - Phone:850-479-2544
Mailing Address - Fax:850-479-7240
Practice Address - Street 1:6314 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7320
Practice Address - Country:US
Practice Address - Phone:850-479-2544
Practice Address - Fax:850-479-7240
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist