Provider Demographics
NPI:1205313343
Name:BEASLEY, EMILY C (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:C
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 21ST ST APT 322
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2371
Mailing Address - Country:US
Mailing Address - Phone:317-292-6719
Mailing Address - Fax:
Practice Address - Street 1:201 W 21ST ST APT 322
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2371
Practice Address - Country:US
Practice Address - Phone:317-292-6719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist