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General NPI Number Information
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NPI Number | 1083043624
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Entity Type | Individual
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Provider Name | JODY SAMANTHA BEACH PHARMD, CCP
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Gender | Female
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 11 TRILBY AVE
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City | WESTVILLE
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State | NJ
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Zip | 08093-1651
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Country | US
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Telephone | 856-229-3904
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Fax |
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Provider Business Mailing Address
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Address Line | 11 TRILBY AVE
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City | WESTVILLE
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State | NJ
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Zip | 08093-1651
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Country | US
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Telephone | 856-229-3904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP443154
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI02898400
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License Number State | NJ
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