Healthcare Provider Details

I. General information

NPI: 1154714186
Provider Name (Legal Business Name): JESSICA BEASLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 COMMERCE DR
BLUEFIELD VA
24605-9221
US

IV. Provider business mailing address

PO BOX S
SALTVILLE VA
24370-1149
US

V. Phone/Fax

Practice location:
  • Phone: 276-322-3834
  • Fax:
Mailing address:
  • Phone: 276-496-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213037
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: