Provider Demographics
NPI:1629722566
Name:BEADLE, ABIGAIL ROSE (RPH)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ROSE
Last Name:BEADLE
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 1:655 CREED ST
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1223
Mailing Address - Country:US
Mailing Address - Phone:330-750-0006
Mailing Address - Fax:330-750-0296
Practice Address - Street 1:655 CREED ST
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1223
Practice Address - Country:US
Practice Address - Phone:330-750-0006
Practice Address - Fax:330-750-0296
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist