Provider Demographics
NPI:1639424328
Name:BEAUREGARD DRUGS INC
Entity Type:Organization
Organization Name:BEAUREGARD DRUGS INC
Other - Org Name:BEAUREGARD DRUGS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TUCKER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-364-9993
Mailing Address - Street 1:7667 AL HIGHWAY 51 STE A
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-2200
Mailing Address - Country:US
Mailing Address - Phone:334-364-9993
Mailing Address - Fax:334-364-9997
Practice Address - Street 1:7667 AL HIGHWAY 51
Practice Address - Street 2:STE A
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-2200
Practice Address - Country:US
Practice Address - Phone:334-364-9993
Practice Address - Fax:334-364-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
AL1139393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136066OtherPK
AL139875Medicaid