Healthcare Provider Details

I. General information

NPI: 1720626104
Provider Name (Legal Business Name): JAMES RICHARD BEARDSLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

1502 HOLGATE DR
GREENSBORO NC
27410-2836
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2011
  • Fax:
Mailing address:
  • Phone: 336-327-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number700227
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: