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General NPI Number Information
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NPI Number | 1659663763
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Entity Type | Individual
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Provider Name | KELLY MARIE BEATS R. PH.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2011
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Last Update Date | 05/07/2011
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Provider Practice Location Address
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Address Line | 2720 W MALLARD CREEK CHURCH RD
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City | CHARLOTTE
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State | NC
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Zip | 28262-2383
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Country | US
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Telephone | 704-717-7438
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Fax | 704-717-7423
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Provider Business Mailing Address
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Address Line | 2720 W MALLARD CREEK CHURCH RD
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City | CHARLOTTE
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State | NC
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Zip | 28262-2383
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Country | US
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Telephone | 704-717-7438
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Fax | 704-717-7423
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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 | 13678
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License Number State | NC
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