Provider Demographics
NPI:1972844686
Name:BEATY, RODNEY O (RPH)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:O
Last Name:BEATY
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 1:701 US HIGHWAY 259 N
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-6041
Mailing Address - Country:US
Mailing Address - Phone:903-983-2892
Mailing Address - Fax:
Practice Address - Street 1:701 US HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-6041
Practice Address - Country:US
Practice Address - Phone:903-983-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist