Provider Demographics
NPI:1821388091
Name:BECKMAN, JOE FREDERICK (RPH)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:FREDERICK
Last Name:BECKMAN
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 1:2380 NASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4145
Mailing Address - Country:US
Mailing Address - Phone:270-842-6301
Mailing Address - Fax:270-842-6110
Practice Address - Street 1:2380 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4145
Practice Address - Country:US
Practice Address - Phone:270-842-6301
Practice Address - Fax:270-842-6110
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist