Provider Demographics
NPI:1548026289
Name:BEYALA, JACQUELINE MIREILLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MIREILLE
Last Name:BEYALA
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 1:10763 VENETIA MILL CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1585
Mailing Address - Country:US
Mailing Address - Phone:240-603-1172
Mailing Address - Fax:
Practice Address - Street 1:75 VALLEY STREAM PKWY
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1459
Practice Address - Country:US
Practice Address - Phone:610-889-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH200004869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist