Provider Demographics
NPI:1275581712
Name:BEAUDRY, JOHN ASHTON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ASHTON
Last Name:BEAUDRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:BEAUDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:112 SMITH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-5113
Mailing Address - Country:US
Mailing Address - Phone:719-252-0322
Mailing Address - Fax:
Practice Address - Street 1:312 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3619
Practice Address - Country:US
Practice Address - Phone:334-289-3657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17649183500000X
WI19658-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist