Provider Demographics
NPI:1710260807
Name:BEASLEY, RONALD EUGENE (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:BEASLEY
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 1:44 MELANIE RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-9021
Mailing Address - Country:US
Mailing Address - Phone:601-446-8459
Mailing Address - Fax:601-442-4050
Practice Address - Street 1:505 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-8440
Practice Address - Country:US
Practice Address - Phone:601-446-7167
Practice Address - Fax:601-442-4050
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06726261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service