Provider Demographics
NPI:1699177196
Name:BEAN, DEREK TROY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:TROY
Last Name:BEAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 NAT WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-2629
Mailing Address - Country:US
Mailing Address - Phone:509-754-8847
Mailing Address - Fax:509-754-8850
Practice Address - Street 1:1399 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2629
Practice Address - Country:US
Practice Address - Phone:509-754-8847
Practice Address - Fax:509-754-8850
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00066590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist