Provider Demographics
NPI:1356482624
Name:BEARD PHARMACIST INC.
Entity Type:Organization
Organization Name:BEARD PHARMACIST INC.
Other - Org Name:BUSSEY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:936-254-2471
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:TIMPSON
Mailing Address - State:TX
Mailing Address - Zip Code:75975-0458
Mailing Address - Country:US
Mailing Address - Phone:936-254-2471
Mailing Address - Fax:936-254-2435
Practice Address - Street 1:443 AUSTIN STREET
Practice Address - Street 2:
Practice Address - City:TIMPSON
Practice Address - State:TX
Practice Address - Zip Code:75975-0458
Practice Address - Country:US
Practice Address - Phone:936-254-2471
Practice Address - Fax:936-254-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4544006OtherNABP
TX142783Medicaid