Provider Demographics
NPI:1801499462
Name:BECKS, JACQUELINE (RPH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BECKS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6280 TOWNSHIP ROAD 82
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9587
Mailing Address - Country:US
Mailing Address - Phone:440-241-7430
Mailing Address - Fax:
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1331
Practice Address - Country:US
Practice Address - Phone:419-483-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03118977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist