Provider Demographics
NPI:1467835587
Name:BEAULIEU, MARCO (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 DES CHALETS RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FALLS
Mailing Address - State:NEW BRUNSWICK
Mailing Address - Zip Code:E3Y3W9
Mailing Address - Country:CA
Mailing Address - Phone:506-475-2697
Mailing Address - Fax:
Practice Address - Street 1:112 BENNETT DR
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2022
Practice Address - Country:US
Practice Address - Phone:207-498-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist