Provider Demographics
NPI:1023395829
Name:BEYERS PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:BEYERS PHARMACY SERVICES INC
Other - Org Name:WELLSPRING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO, PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:510-428-1559
Mailing Address - Street 1:4184 PIEDMONT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5174
Mailing Address - Country:US
Mailing Address - Phone:510-428-1559
Mailing Address - Fax:510-428-1670
Practice Address - Street 1:4184 PIEDMONT AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5174
Practice Address - Country:US
Practice Address - Phone:510-428-1559
Practice Address - Fax:510-428-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
CA508143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132813OtherPK
CA1023395829Medicaid