Provider Demographics
NPI:1831149178
Name:BEDDINGFIELD, THOMAS RYAN (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RYAN
Last Name:BEDDINGFIELD
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 1:3945 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2817
Mailing Address - Country:US
Mailing Address - Phone:770-935-0061
Mailing Address - Fax:770-935-0069
Practice Address - Street 1:3945 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2817
Practice Address - Country:US
Practice Address - Phone:770-935-0061
Practice Address - Fax:770-935-0069
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH 0186881835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy