1518215052 NPI number — MR. JAMES RICHEY BEACH LICENSED DISPENSING

Table of content: MR. JAMES RICHEY BEACH LICENSED DISPENSING (NPI 1518215052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518215052 NPI number — MR. JAMES RICHEY BEACH LICENSED DISPENSING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEACH
Provider First Name:
JAMES
Provider Middle Name:
RICHEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED DISPENSING
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518215052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4833 WESTCHESTER DRIVE
Provider Second Line Business Mailing Address:
APT. 118
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44515-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-503-8675
Provider Business Mailing Address Fax Number:
330-799-4515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4833 WESTCHESTER DRIVE
Provider Second Line Business Practice Location Address:
APT. 118
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44515-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-503-8675
Provider Business Practice Location Address Fax Number:
330-799-4515
Provider Enumeration Date:
08/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4514SC , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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