Provider Demographics
NPI:1063702736
Name:BEARD, THOMAS DWIGHT (DPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DWIGHT
Last Name:BEARD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3802
Mailing Address - Country:US
Mailing Address - Phone:615-809-2149
Mailing Address - Fax:
Practice Address - Street 1:5192 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2712
Practice Address - Country:US
Practice Address - Phone:615-213-2222
Practice Address - Fax:615-213-2227
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist