Provider Demographics
NPI:1619171394
Name:BEAM, DAVID LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:BEAM
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 1:458 OLD MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-2066
Mailing Address - Country:US
Mailing Address - Phone:704-528-3106
Mailing Address - Fax:704-642-0954
Practice Address - Street 1:820 KLUMAC RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5722
Practice Address - Country:US
Practice Address - Phone:704-642-0952
Practice Address - Fax:704-642-0954
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08381OtherNC PHARMACIST LICENSE #