Provider Demographics
NPI:1821689738
Name:BEATTY, NICOLAS (RPH)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:BEATTY
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 1:12459 US-22
Mailing Address - Street 2:
Mailing Address - City:SABINA
Mailing Address - State:OH
Mailing Address - Zip Code:45169
Mailing Address - Country:US
Mailing Address - Phone:937-584-2424
Mailing Address - Fax:937-584-5348
Practice Address - Street 1:12459 US-22
Practice Address - Street 2:
Practice Address - City:SABINA
Practice Address - State:OH
Practice Address - Zip Code:45169
Practice Address - Country:US
Practice Address - Phone:937-584-2424
Practice Address - Fax:937-584-5348
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03135569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist