Provider Demographics
NPI:1255312658
Name:BECKMANS PRESCRIPTION SHOP
Entity Type:Organization
Organization Name:BECKMANS PRESCRIPTION SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:615-893-6661
Mailing Address - Street 1:120 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3723
Mailing Address - Country:US
Mailing Address - Phone:615-893-6661
Mailing Address - Fax:615-849-8344
Practice Address - Street 1:120 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3723
Practice Address - Country:US
Practice Address - Phone:615-893-6661
Practice Address - Fax:615-849-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3525371Medicaid
TN3525371Medicaid