Healthcare Provider Details

I. General information

NPI: 1073143715
Provider Name (Legal Business Name): TIM BEECKLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GAINSBOROUGH SQ
CHESAPEAKE VA
23320-1707
US

IV. Provider business mailing address

916 KINGS LANDING CIR
VIRGINIA BEACH VA
23452-4648
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-2456
  • Fax:
Mailing address:
  • Phone: 757-679-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202206253
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: