Provider Demographics
NPI:1053444562
Name:BEARDEN, RICKY (RPH)
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:
Last Name:BEARDEN
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 1:406 SHANE LN
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-6534
Mailing Address - Country:US
Mailing Address - Phone:256-538-5850
Mailing Address - Fax:256-538-1860
Practice Address - Street 1:1433 3RD ST SW
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-1132
Practice Address - Country:US
Practice Address - Phone:256-538-5850
Practice Address - Fax:256-538-1860
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist