Healthcare Provider Details

I. General information

NPI: 1083711477
Provider Name (Legal Business Name): BEASLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CHURCH ST
COLUMBIA AL
36319-0614
US

IV. Provider business mailing address

PO BOX 614
COLUMBIA AL
36319-0614
US

V. Phone/Fax

Practice location:
  • Phone: 334-696-4611
  • Fax: 334-696-4669
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number110551
License Number StateAL

VIII. Authorized Official

Name: BREANNA NORTH
Title or Position: SUPERVISING PHARM
Credential: PHARM.D.
Phone: 334-696-4611