Provider Demographics
NPI:1295837052
Name:BEALE, JAMES HARWORTH (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HARWORTH
Last Name:BEALE
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 1:4040 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-9576
Mailing Address - Country:US
Mailing Address - Phone:912-285-5473
Mailing Address - Fax:912-283-9797
Practice Address - Street 1:1710 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5216
Practice Address - Country:US
Practice Address - Phone:912-283-1151
Practice Address - Fax:912-283-9797
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist