=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922640119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATTY BECK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2019
-----------------------------------------------------
Last Update Date | 10/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N APPLEGATE ST STE A
-----------------------------------------------------
City | WINONA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38967-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-283-1393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 285
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38917-0285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | E08938
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------