Healthcare Provider Details

I. General information

NPI: 1982370466
Provider Name (Legal Business Name): ROBERT WAYNE BEAUDOIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3092 N EASTMAN RD STE 100
LONGVIEW TX
75605-7950
US

IV. Provider business mailing address

693 WHITE BEAR TRL
LINDALE TX
75771-6659
US

V. Phone/Fax

Practice location:
  • Phone: 903-323-5001
  • Fax:
Mailing address:
  • Phone: 903-423-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76698
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: