Provider Demographics
NPI:1083711477
Name:BEASLEY PHARMACY INC
Entity Type:Organization
Organization Name:BEASLEY PHARMACY INC
Other - Org Name:BEASLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARM
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:334-696-4611
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:36319-0614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:AL
Practice Address - Zip Code:36319-0614
Practice Address - Country:US
Practice Address - Phone:334-696-4611
Practice Address - Fax:334-696-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1105513336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1988611OtherPK
AL100039160Medicaid