Provider Demographics
NPI:1275828832
Name:BEAMAN, BRANDON
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:BEAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 E US HIGHWAY 36
Mailing Address - Street 2:T-1788
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10209 E US HIGHWAY 36
Practice Address - Street 2:T-1788
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7985
Practice Address - Country:US
Practice Address - Phone:317-271-6598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022050A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist