Provider Demographics
NPI:1952711426
Name:BEATTY, ABRAHAM MARTIN (RPH)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:MARTIN
Last Name:BEATTY
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 1:582 BAY POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5151
Mailing Address - Country:US
Mailing Address - Phone:248-236-8033
Mailing Address - Fax:248-236-8065
Practice Address - Street 1:900 N LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-3619
Practice Address - Country:US
Practice Address - Phone:248-236-8033
Practice Address - Fax:248-236-8065
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020300831835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy