Provider Demographics
NPI:1689959652
Name:BEAUVAIS, COURTNEY
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:BEAUVAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1721
Mailing Address - Country:US
Mailing Address - Phone:810-653-4020
Mailing Address - Fax:810-653-9174
Practice Address - Street 1:901 S STATE RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1721
Practice Address - Country:US
Practice Address - Phone:810-653-4020
Practice Address - Fax:810-653-9174
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI290101040742275183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician