Provider Demographics
NPI:1598937021
Name:BECKER, JAMES GERARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GERARD
Last Name:BECKER
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 1:823 COUNTY ROAD 2270
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-7922
Mailing Address - Country:US
Mailing Address - Phone:573-729-0969
Mailing Address - Fax:
Practice Address - Street 1:1375 E 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3591
Practice Address - Country:US
Practice Address - Phone:573-364-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist