Provider Demographics
NPI:1073143715
Name:BEECKLER, TIM
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:BEECKLER
Suffix:
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 1:916 KINGS LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4648
Mailing Address - Country:US
Mailing Address - Phone:757-679-5565
Mailing Address - Fax:
Practice Address - Street 1:101 GAINSBOROUGH SQ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1707
Practice Address - Country:US
Practice Address - Phone:757-547-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist