Provider Demographics
NPI:1891794046
Name:BECTON, JOE D (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:D
Last Name:BECTON
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 1:1919 S LOOP 256
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5915
Mailing Address - Country:US
Mailing Address - Phone:903-723-2880
Mailing Address - Fax:903-723-1910
Practice Address - Street 1:1919 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5915
Practice Address - Country:US
Practice Address - Phone:903-723-2880
Practice Address - Fax:903-723-1910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16643OtherSTATE PHARMACIST #