1750419446 NPI number — BECKHAMS HHC PHARMACY INC

Table of content: MRS. MARY RANDOLPH APN-C (NPI 1720246937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750419446 NPI number — BECKHAMS HHC PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BECKHAMS HHC PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1750419446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1194 WARM SPRINGS HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31816-1166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-846-2002
Provider Business Mailing Address Fax Number:
706-846-2161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1194 WARM SPRINGS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31816-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-846-2002
Provider Business Practice Location Address Fax Number:
706-846-2161
Provider Enumeration Date:
03/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BECKHAM
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PHARMACIST IN CHARGE
Authorized Official Telephone Number:
706-846-2002

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH011683 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PHRE007270 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000453384A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".