Provider Demographics
NPI:1194036806
Name:BEARD, JUDI L (DPH)
Entity type:Individual
Prefix:MRS
First Name:JUDI
Middle Name:L
Last Name:BEARD
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BROYLES RD
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37690-2133
Mailing Address - Country:US
Mailing Address - Phone:423-502-8169
Mailing Address - Fax:
Practice Address - Street 1:2755 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-0955
Practice Address - Country:US
Practice Address - Phone:423-525-4221
Practice Address - Fax:423-525-4783
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0007592OtherSTATE PHARMACIST LICENSE