Provider Demographics
NPI:1952948747
Name:BEAUDREAU, LUC (RPH)
Entity Type:Individual
Prefix:MR
First Name:LUC
Middle Name:
Last Name:BEAUDREAU
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 1:3515 SNOWDEN LN
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8662
Mailing Address - Country:US
Mailing Address - Phone:734-718-4159
Mailing Address - Fax:
Practice Address - Street 1:10059 E HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1367
Practice Address - Country:US
Practice Address - Phone:810-991-2352
Practice Address - Fax:810-991-2354
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020259301835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist