Provider Demographics
NPI:1366729972
Name:BEANE, THOMAS STRAUGHAN JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:STRAUGHAN
Last Name:BEANE
Suffix:JR
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:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:WICOMICO CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22579-0238
Mailing Address - Country:US
Mailing Address - Phone:804-580-7823
Mailing Address - Fax:
Practice Address - Street 1:573 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3828
Practice Address - Country:US
Practice Address - Phone:804-435-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0202004546OtherCOMMONWEALTH OF VIRGINIA