MEDICARE: DR. TRACI ANDREA BEASLEY PHARM.D., R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	012235	KY

General Provider Information

NPI Number	:	1225735525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACI ANDREA BEASLEY PHARM.D., R.PH.

Provider Business Mailing Address
First Line	:	117 DOVE TRACE DR
Second Line	:
City	:	MOUNT STERLING
State	:	KY
Zip	:	40353-8313
Country	:	US
Telephone Number	:	859-585-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	644 MAYSVILLE RD
Second Line	:
City	:	MOUNT STERLING
State	:	KY
Zip	:	40353-9464
Country	:	US
Telephone Number	:	859-498-3141
Fax Number	:	859-498-2434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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