Provider Demographics
NPI:1275690448
Name:BEASLEY, WILLIAM MARTIN SR
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARTIN
Last Name:BEASLEY
Suffix:SR
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:AL
Mailing Address - Zip Code:36016-0220
Mailing Address - Country:US
Mailing Address - Phone:334-775-3442
Mailing Address - Fax:334-775-7711
Practice Address - Street 1:23 COURT SQUARE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:AL
Practice Address - Zip Code:36016-0220
Practice Address - Country:US
Practice Address - Phone:334-775-3442
Practice Address - Fax:334-775-7711
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist