Healthcare Provider Details

I. General information

NPI: 1124135538
Provider Name (Legal Business Name): BEAUMONT PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/07/2023
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CALDER AVE.
BEAUMONT TX
77702-1411
US

IV. Provider business mailing address

3110 CALDER ST
BEAUMONT TX
77702-1411
US

V. Phone/Fax

Practice location:
  • Phone: 409-866-1429
  • Fax: 409-866-3735
Mailing address:
  • Phone: 409-866-1429
  • Fax: 409-866-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TREY HANEY
Title or Position: MANAGER
Credential:
Phone: 409-769-2406