Provider Demographics
NPI:1215909031
Name:BECK, JEFFREY DANIEL (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANIEL
Last Name:BECK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 UPPER FOREST VW
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5665
Mailing Address - Country:US
Mailing Address - Phone:301-707-0958
Mailing Address - Fax:
Practice Address - Street 1:16117 MCMULLEN HWY SW
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6207
Practice Address - Country:US
Practice Address - Phone:301-729-2600
Practice Address - Fax:301-729-1982
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11730183500000X
PARP036981T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP04852OtherMD BOARD OF PHARMACY PERMIT