Provider Demographics
NPI:1649344672
Name:BERRY, BECKY ODHAM (PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:ODHAM
Last Name:BERRY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2542
Mailing Address - Country:US
Mailing Address - Phone:252-208-4265
Mailing Address - Fax:252-208-4267
Practice Address - Street 1:2415 W VERNON AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-3337
Practice Address - Country:US
Practice Address - Phone:252-521-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist