Provider Demographics
NPI:1861006306
Name:BEATTY, COLLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:BEATTY
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 1:2921 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-3540
Mailing Address - Country:US
Mailing Address - Phone:713-899-3331
Mailing Address - Fax:
Practice Address - Street 1:2921 NOBLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-3540
Practice Address - Country:US
Practice Address - Phone:713-899-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist