Healthcare Provider Details

I. General information

NPI: 1275581712
Provider Name (Legal Business Name): JOHN ASHTON BEAUDRY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN BEAUDRY PHARMD

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 US HIGHWAY 80 W
DEMOPOLIS AL
36732-4102
US

IV. Provider business mailing address

1315 PHILLIPS DR
DEMOPOLIS AL
36732-3534
US

V. Phone/Fax

Practice location:
  • Phone: 334-289-2385
  • Fax:
Mailing address:
  • Phone: 719-252-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14284
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17649
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19658-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: