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General NPI Number Information
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NPI Number | 1740741479
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Entity Type | Individual
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Provider Name | MR. JESS OWEN BEAVERS
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Gender | Male
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 13320 G.C. PEERY HWY
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City | POUNDING MILL
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State | VA
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Zip | 24637
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Country | US
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Telephone | 276-596-9116
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Fax | 276-596-9139
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | TAZEWELL
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State | VA
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Zip | 24651-0002
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Country | US
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Telephone | 276-596-9116
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Fax | 276-596-9139
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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 | 0202007751
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License Number State | VA
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