Provider Demographics
NPI:1285924076
Name:BEATY, DALE ERVIN (RPH)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ERVIN
Last Name:BEATY
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 1:3330 MONTGOMERY WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-0833
Mailing Address - Country:US
Mailing Address - Phone:270-781-8958
Mailing Address - Fax:
Practice Address - Street 1:205 WEST G L SMITH STREET
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261
Practice Address - Country:US
Practice Address - Phone:270-526-5615
Practice Address - Fax:270-526-6713
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist