Provider Demographics
NPI:1861006306
Name:BEATTY, COLLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:BEATTY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 JUNCTION DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2253
Mailing Address - Country:US
Mailing Address - Phone:804-752-2093
Mailing Address - Fax:
Practice Address - Street 1:133 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2253
Practice Address - Country:US
Practice Address - Phone:804-752-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist