Provider Demographics
NPI:1932259421
Name:BECKMAN, JOHN ALBERT (PD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:BECKMAN
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11507 MEXICO FARMS RD SE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6471
Mailing Address - Country:US
Mailing Address - Phone:301-777-7336
Mailing Address - Fax:301-777-3860
Practice Address - Street 1:686 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2734
Practice Address - Country:US
Practice Address - Phone:301-777-7336
Practice Address - Fax:301-777-3860
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist