Provider Demographics
NPI:1659663763
Name:BEATS, KELLY MARIE (R PH)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:BEATS
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W MALLARD CREEK CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2383
Mailing Address - Country:US
Mailing Address - Phone:704-717-7438
Mailing Address - Fax:704-717-7423
Practice Address - Street 1:2720 W MALLARD CREEK CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2383
Practice Address - Country:US
Practice Address - Phone:704-717-7438
Practice Address - Fax:704-717-7423
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist