Healthcare Provider Details

I. General information

NPI: 1538138110
Provider Name (Legal Business Name): BRIAN HOUSTON BEASLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

368 BELGRADE SWANSBORO RD
STELLA NC
28582-9613
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4172
  • Fax:
Mailing address:
  • Phone: 910-326-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14137
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: