Individual
JORDAN TIMOTHY BEATTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9917A SPANISH FORT BLVD, SPANISH FORT, AL 36527-5603
(251) 626-3113
Mailing address
9917A SPANISH FORT BLVD, SPANISH FORT, AL 36527-5603
(251) 626-3113
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
19542
AL
390200000X
Student in an Organized Health Care Education/Training Program
S10665
AL
Other
Enumeration date
05/07/2013
Last updated
11/24/2020
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