Healthcare Provider Details

I. General information

NPI: 1497844047
Provider Name (Legal Business Name): THE BEAVERTON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W BROWN ST
BEAVERTON MI
48612-8119
US

IV. Provider business mailing address

PO BOX 575
BEAVERTON MI
48612-0575
US

V. Phone/Fax

Practice location:
  • Phone: 989-435-7778
  • Fax: 989-435-2581
Mailing address:
  • Phone:
  • 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 Number5301005882
License Number StateMI

VIII. Authorized Official

Name: ROBERT RIFFERT
Title or Position: PHARMACIST PRESIDENT
Credential:
Phone: 989-435-7778