Provider Demographics
NPI:1871825349
Name:BEATY, LOUIE KENT (RPH)
Entity Type:Individual
Prefix:
First Name:LOUIE
Middle Name:KENT
Last Name:BEATY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:LEWIS
Other - Middle Name:KENT
Other - Last Name:BEATY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:9728 PHINNEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3028
Mailing Address - Country:US
Mailing Address - Phone:305-898-3130
Mailing Address - Fax:
Practice Address - Street 1:12400 E MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-2559
Practice Address - Country:US
Practice Address - Phone:305-898-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS-00010077183500000X
FLPS0033867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist