Provider Demographics
NPI:1750419446
Name:BECKHAMS HHC PHARMACY INC
Entity type:Organization
Organization Name:BECKHAMS HHC PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-846-2002
Mailing Address - Street 1:1194 WARM SPRINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31816-1166
Mailing Address - Country:US
Mailing Address - Phone:706-846-2002
Mailing Address - Fax:706-846-2161
Practice Address - Street 1:1194 WARM SPRINGS HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:GA
Practice Address - Zip Code:31816-1166
Practice Address - Country:US
Practice Address - Phone:706-846-2002
Practice Address - Fax:706-846-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011683183500000X
332B00000X
GAPHRE007270333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000453384AMedicaid
GA6728000001Medicare NSC