Provider Demographics
NPI:1467660985
Name:BEAUMONT, JESSICA KATHRYN (RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATHRYN
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:RPH
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 441
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IL
Mailing Address - Zip Code:62468-0441
Mailing Address - Country:US
Mailing Address - Phone:217-923-3922
Mailing Address - Fax:
Practice Address - Street 1:170 COURT HOUSE SQUARE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IL
Practice Address - Zip Code:62468
Practice Address - Country:US
Practice Address - Phone:217-849-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist