Provider Demographics
NPI:1669509535
Name:BEARD, ROLAND EDWARD
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:EDWARD
Last Name:BEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S DREW ST
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-5106
Mailing Address - Country:US
Mailing Address - Phone:870-628-4277
Mailing Address - Fax:870-628-4278
Practice Address - Street 1:107 S DREW ST
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-5106
Practice Address - Country:US
Practice Address - Phone:870-628-4277
Practice Address - Fax:870-628-4278
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR07163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist