Provider Demographics
NPI:1699072298
Name:BEAVERS, TERRELL (PD)
Entity type:Individual
Prefix:
First Name:TERRELL
Middle Name:
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 CHANBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8673
Mailing Address - Country:US
Mailing Address - Phone:870-623-0718
Mailing Address - Fax:
Practice Address - Street 1:5745 CHANBERRY LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8673
Practice Address - Country:US
Practice Address - Phone:870-623-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD6543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist