Provider Demographics
NPI:1528382520
Name:RADER, BEAU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BEAU
Middle Name:
Last Name:RADER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CHURCH ST
Mailing Address - Street 2:UNIT 2206
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 CHURCH ST
Practice Address - Street 2:UNIT 2206
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219-2308
Practice Address - Country:US
Practice Address - Phone:205-447-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist