Healthcare Provider Details

I. General information

NPI: 1770702359
Provider Name (Legal Business Name): COURTNEY J BEAUMONT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY J CARR RPH

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/06/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MERCHANT ST
EFFINGHAM IL
62401-2425
US

IV. Provider business mailing address

500 COUNTY ROAD 1225 E
TOLEDO IL
62468-4137
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-4301
  • Fax: 217-347-5597
Mailing address:
  • Phone: 217-246-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051287354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: