Provider Demographics
NPI:1245388495
Name:BEATY, DUSTIN J
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:J
Last Name:BEATY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 HIDDEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7263
Mailing Address - Country:US
Mailing Address - Phone:205-522-9583
Mailing Address - Fax:
Practice Address - Street 1:201 19TH ST E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5457
Practice Address - Country:US
Practice Address - Phone:205-387-1403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist