Provider Demographics
NPI:1578008967
Name:BEATY, ANNE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARIE
Last Name:BEATY
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 1:1722 GRUBER RD
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7901
Mailing Address - Country:US
Mailing Address - Phone:910-907-9484
Mailing Address - Fax:910-907-9485
Practice Address - Street 1:1722 GRUBER RD
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7901
Practice Address - Country:US
Practice Address - Phone:910-907-9484
Practice Address - Fax:910-907-9485
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist