Provider Demographics
NPI:1114272671
Name:BECK, WALDO FREDERICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALDO
Middle Name:FREDERICK
Last Name:BECK
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 1:1042 NORD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-4308
Mailing Address - Country:US
Mailing Address - Phone:530-566-1358
Mailing Address - Fax:530-566-1362
Practice Address - Street 1:1042 NORD AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4308
Practice Address - Country:US
Practice Address - Phone:530-566-1358
Practice Address - Fax:530-566-1362
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist