Provider Demographics
NPI:1881920494
Name:BEAMAN, MARK A (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BEAMAN
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 1:3830 GLADE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4829
Mailing Address - Country:US
Mailing Address - Phone:817-283-3786
Mailing Address - Fax:817-283-8492
Practice Address - Street 1:3830 GLADE RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-4829
Practice Address - Country:US
Practice Address - Phone:817-283-3786
Practice Address - Fax:817-283-8492
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist