Provider Demographics
NPI:1760719256
Name:BEAM, ADAM BLAKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:BLAKE
Last Name:BEAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-4099
Mailing Address - Country:US
Mailing Address - Phone:940-552-2999
Mailing Address - Fax:
Practice Address - Street 1:1720 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4099
Practice Address - Country:US
Practice Address - Phone:940-552-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist