Provider Demographics
NPI:1679179345
Name:BECKMAN, BRENDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2474
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958-2474
Mailing Address - Country:US
Mailing Address - Phone:870-223-6252
Mailing Address - Fax:
Practice Address - Street 1:2219 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2007
Practice Address - Country:US
Practice Address - Phone:918-647-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18097183500000X
ARPD10484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist