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NPI Code Detail

MEDICARE: MR. BURL G. BEASLEY DPH

MEDICARE: MR. BURL G. BEASLEY DPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy Pharmacist11369OK

General Provider Information

NPI Number : 1730178930
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BURL G. BEASLEY DPH
Provider Business Mailing Address
First Line : 2201 NW 44TH CT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-8385
Country : US
Telephone Number : 405-210-2502
Fax Number :
Provider Business Practice Location Address
First Line : 2201 NW 44TH CT
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-8385
Country : US
Telephone Number : 405-210-2502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 05/07/2014

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