Provider Demographics
NPI:1336393024
Name:BEQUETTE, PAULA J (RPH)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:BEQUETTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 E LOW CROSSINGS RD
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65255-9541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6170 E LOW CROSSINGS RD
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65255-9541
Practice Address - Country:US
Practice Address - Phone:573-696-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist