Provider Demographics
NPI:1699394650
Name:BEATY, MELANIE CAROL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:CAROL
Last Name:BEATY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BICKNELL RD
Mailing Address - Street 2:
Mailing Address - City:CLARKRANGE
Mailing Address - State:TN
Mailing Address - Zip Code:38553-5123
Mailing Address - Country:US
Mailing Address - Phone:931-510-2744
Mailing Address - Fax:
Practice Address - Street 1:1500 BICKNELL RD
Practice Address - Street 2:
Practice Address - City:CLARKRANGE
Practice Address - State:TN
Practice Address - Zip Code:38553-5123
Practice Address - Country:US
Practice Address - Phone:931-510-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist