Healthcare Provider Details

I. General information

NPI: 1760719256
Provider Name (Legal Business Name): ADAM BLAKE BEAM PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HILLCREST DR
VERNON TX
76384-4099
US

IV. Provider business mailing address

1720 HILLCREST DR
VERNON TX
76384-4099
US

V. Phone/Fax

Practice location:
  • Phone: 940-552-2999
  • Fax:
Mailing address:
  • Phone: 940-552-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47326
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: