Provider Demographics
NPI:1558633578
Name:BEAN, RHONDA H (RPH)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:H
Last Name:BEAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 VILLAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0081
Mailing Address - Country:US
Mailing Address - Phone:704-536-3663
Mailing Address - Fax:704-536-5865
Practice Address - Street 1:2325 VILLAGE LAKE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-0081
Practice Address - Country:US
Practice Address - Phone:704-536-3663
Practice Address - Fax:704-536-5865
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist