Provider Demographics
NPI:1598360323
Name:BECK, ROBERT LEE JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:BECK
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 TUSCAN WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1832
Mailing Address - Country:US
Mailing Address - Phone:904-940-3817
Mailing Address - Fax:
Practice Address - Street 1:57 TUSCAN WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1832
Practice Address - Country:US
Practice Address - Phone:904-940-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty