Provider Demographics
NPI:1093835597
Name:BEEKMAN, WAYNE R (RPH)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:R
Last Name:BEEKMAN
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 1:12538 SR 78
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-6866
Mailing Address - Country:US
Mailing Address - Phone:217-496-6063
Mailing Address - Fax:
Practice Address - Street 1:1400 E PERSHING RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4733
Practice Address - Country:US
Practice Address - Phone:217-875-9364
Practice Address - Fax:217-875-9377
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051029800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist