Healthcare Provider Details

I. General information

NPI: 1417330937
Provider Name (Legal Business Name): ALLISON BEATTY PHARMD, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-2316
US

IV. Provider business mailing address

1380 S LINCOLN ST
SALT LAKE CITY UT
84105-2316
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 928-713-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number9053252-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: