MEDICARE: CODY R BEAUMONT PHARMD

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	RPH0010764	OR
2	183500000X	Pharmacist	3604171701	UT

General Provider Information

NPI Number	:	1235151184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY R BEAUMONT PHARMD

Provider Business Mailing Address
First Line	:	4261 GARY ST
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603
Country	:	US
Telephone Number	:	541-273-2839
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865 DAGGETT AVE
Second Line	:	MERLE WEST MEDICAL CENTER
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601
Country	:	US
Telephone Number	:	541-883-6263
Fax Number	:	541-883-6216

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	07/08/2007

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Directions to “ CODY R BEAUMONT PHARMD” Practice Location

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