Provider Demographics
NPI:1740335371
Name:BEARD, THOMAS DERRELL JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DERRELL
Last Name:BEARD
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 EADS BLUFF RD NW
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37336-4940
Mailing Address - Country:US
Mailing Address - Phone:423-336-9777
Mailing Address - Fax:
Practice Address - Street 1:4632 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3013
Practice Address - Country:US
Practice Address - Phone:423-894-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist