Provider Demographics
NPI:1942519848
Name:BECKHAM, GARY PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:PAUL
Last Name:BECKHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4108
Mailing Address - Country:US
Mailing Address - Phone:601-267-3293
Mailing Address - Fax:601-267-8618
Practice Address - Street 1:300 S PEARL ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4108
Practice Address - Country:US
Practice Address - Phone:601-267-3293
Practice Address - Fax:601-267-8618
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist