Provider Demographics
NPI:1720369994
Name:BEAUMONT PHARMACY, LLC
Entity Type:Organization
Organization Name:BEAUMONT PHARMACY, LLC
Other - Org Name:BEAUMONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-777-1680
Mailing Address - Street 1:264 INVERNESS CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-991-7171
Mailing Address - Fax:205-991-7179
Practice Address - Street 1:264 INVERNESS CENTER DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4834
Practice Address - Country:US
Practice Address - Phone:205-991-7171
Practice Address - Fax:205-991-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL399173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137340OtherNCPDP PROVIDER IDENTIFICATION NUMBER