Provider Demographics
NPI:1447800198
Name:JONATHAN BEASLEY PHARMACY INC
Entity Type:Organization
Organization Name:JONATHAN BEASLEY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-695-0144
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-0456
Mailing Address - Country:US
Mailing Address - Phone:205-695-0144
Mailing Address - Fax:205-695-0139
Practice Address - Street 1:55314 HIGHWAY 17 STE D
Practice Address - Street 2:
Practice Address - City:SULLIGENT
Practice Address - State:AL
Practice Address - Zip Code:35586-4546
Practice Address - Country:US
Practice Address - Phone:205-695-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONATHAN BEASLEY PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy