Provider Demographics
NPI:1083738983
Name:BECKER, DAVID W (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:BECKER
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 1:36 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2064
Mailing Address - Country:US
Mailing Address - Phone:508-293-0007
Mailing Address - Fax:904-216-3096
Practice Address - Street 1:520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3576
Practice Address - Country:US
Practice Address - Phone:508-775-9211
Practice Address - Fax:508-775-3864
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist