Provider Demographics
NPI:1841504982
Name:BEAULIEU, KIRK JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:JAMES
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 1:65 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1423
Mailing Address - Country:US
Mailing Address - Phone:207-862-4900
Mailing Address - Fax:
Practice Address - Street 1:65 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1423
Practice Address - Country:US
Practice Address - Phone:207-862-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2725183500000X
MEPR4288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist