MEDICARE: DR. BEAUX COLE PHARM. D.

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	051290641	IL

General Provider Information

NPI Number	:	1376663377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEAUX COLE PHARM. D.

Provider Business Mailing Address
First Line	:	2008 SUBSTATION RD
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-6217
Country	:	US
Telephone Number	:	217-243-4148
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 SUBSTATION RD
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-6217
Country	:	US
Telephone Number	:	217-371-2925
Fax Number	:

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

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	07/10/2019

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