Provider Demographics
NPI:1346840063
Name:BECK, WALTER ROBERT
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:ROBERT
Last Name:BECK
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 1:19312 LIGHTHOUSE PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-6158
Mailing Address - Country:US
Mailing Address - Phone:302-227-5954
Mailing Address - Fax:844-411-6344
Practice Address - Street 1:19312 LIGHTHOUSE PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6158
Practice Address - Country:US
Practice Address - Phone:302-227-5954
Practice Address - Fax:844-411-6344
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist