Provider Demographics
NPI:1689972424
Name:BEAMON, JERRY LYNN
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LYNN
Last Name:BEAMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 KNIGHTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:STANTONSBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27883-9247
Mailing Address - Country:US
Mailing Address - Phone:252-236-5197
Mailing Address - Fax:
Practice Address - Street 1:2650 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1619
Practice Address - Country:US
Practice Address - Phone:252-243-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist