Healthcare Provider Details

I. General information

NPI: 1841351616
Provider Name (Legal Business Name): PHILIP BEARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WEST 7TH AVE
OBERLIN LA
70655-0189
US

IV. Provider business mailing address

PO BOX 189
OBERLIN LA
70655-0189
US

V. Phone/Fax

Practice location:
  • Phone: 337-639-4367
  • Fax: 337-639-4202
Mailing address:
  • Phone: 337-639-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY002488IR
License Number StateLA

VIII. Authorized Official

Name: PHILIP BEARD
Title or Position: OWNER
Credential: PD RPH
Phone: 337-639-4367