Provider Demographics
NPI:1225101959
Name:B L BEARDEN, INC
Entity Type:Organization
Organization Name:B L BEARDEN, INC
Other - Org Name:MURRAYVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:EDSEL
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-2245
Mailing Address - Street 1:5304 THOMPSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MURRAYVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30564-1941
Mailing Address - Country:US
Mailing Address - Phone:770-534-2245
Mailing Address - Fax:770-534-2093
Practice Address - Street 1:5304 THOMPSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MURRAYVILLE
Practice Address - State:GA
Practice Address - Zip Code:30564-1941
Practice Address - Country:US
Practice Address - Phone:770-534-2245
Practice Address - Fax:770-534-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0074453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000902888AMedicaid
GA000902888AMedicaid