Healthcare Provider Details

I. General information

NPI: 1003948506
Provider Name (Legal Business Name): JAMES ROBERT BECK PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W RAVINE RD WELLMONT OUTPATIENT PHARMACY
KINGSPORT TN
37660-3837
US

IV. Provider business mailing address

301 ARBOR TER
KINGSPORT TN
37660-7598
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-6860
  • Fax: 423-224-5654
Mailing address:
  • Phone: 423-246-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000000598
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: