Provider Demographics
NPI:1518523166
Name:BEARD, JOE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BEARD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 KELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4719
Mailing Address - Country:US
Mailing Address - Phone:940-692-7081
Mailing Address - Fax:940-692-9676
Practice Address - Street 1:4426 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-4719
Practice Address - Country:US
Practice Address - Phone:940-692-7081
Practice Address - Fax:940-692-9676
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist