Healthcare Provider Details

I. General information

NPI: 1053444562
Provider Name (Legal Business Name): RICKY BEARDEN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 3RD ST SW
ATTALLA AL
35954-1132
US

IV. Provider business mailing address

406 SHANE LN
RAINBOW CITY AL
35906-6534
US

V. Phone/Fax

Practice location:
  • Phone: 256-538-5850
  • Fax: 256-538-1860
Mailing address:
  • Phone: 256-538-5850
  • Fax: 256-538-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7354
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: