Provider Demographics
NPI:1770967887
Name:TIAN, BEICHEN (RPH)
Entity type:Individual
Prefix:DR
First Name:BEICHEN
Middle Name:
Last Name:TIAN
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 1:7590 OMNI LN
Mailing Address - Street 2:APT 108
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5444
Mailing Address - Country:US
Mailing Address - Phone:941-228-9113
Mailing Address - Fax:
Practice Address - Street 1:100 HANCOCK BRIDGE PKWY W
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2088
Practice Address - Country:US
Practice Address - Phone:239-458-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist