Provider Demographics
NPI:1194320374
Name:BEARD, ELAINE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NE RICE RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-2979
Mailing Address - Country:US
Mailing Address - Phone:816-524-6377
Mailing Address - Fax:816-246-5842
Practice Address - Street 1:189 NE 51ST RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-8275
Practice Address - Country:US
Practice Address - Phone:660-238-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist