Provider Demographics
NPI:1477845626
Name:BEAMS, BRADLY (RPH)
Entity Type:Individual
Prefix:
First Name:BRADLY
Middle Name:
Last Name:BEAMS
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 1:1113 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-2162
Mailing Address - Country:US
Mailing Address - Phone:269-279-9702
Mailing Address - Fax:
Practice Address - Street 1:1113 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2162
Practice Address - Country:US
Practice Address - Phone:269-279-9702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027290183500000X
OH03213963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist