Provider Demographics
NPI:1942641956
Name:BEAM, HENRY LEE III
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LEE
Last Name:BEAM
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:HL
Other - Middle Name:
Other - Last Name:BEAM
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021-3407
Mailing Address - Country:US
Mailing Address - Phone:704-435-6011
Mailing Address - Fax:704-286-7096
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-3407
Practice Address - Country:US
Practice Address - Phone:704-435-6011
Practice Address - Fax:704-286-7096
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6496183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician