Provider Demographics
NPI:1952684383
Name:BEALE, CAROLYN MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MARIE
Last Name:BEALE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LOCKMEADE WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-8155
Mailing Address - Country:US
Mailing Address - Phone:678-817-7583
Mailing Address - Fax:
Practice Address - Street 1:7935 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2205
Practice Address - Country:US
Practice Address - Phone:678-479-1976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist