Provider Demographics
NPI:1649572595
Name:BECK, FLETCHER CALVIN (RPH)
Entity Type:Individual
Prefix:
First Name:FLETCHER
Middle Name:CALVIN
Last Name:BECK
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 1:3208 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1508
Mailing Address - Country:US
Mailing Address - Phone:719-542-3389
Mailing Address - Fax:719-542-3389
Practice Address - Street 1:3208 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1508
Practice Address - Country:US
Practice Address - Phone:719-542-3389
Practice Address - Fax:719-542-3389
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist