Provider Demographics
NPI:1154421659
Name:BEASLEY, TYRON C (RPH)
Entity type:Individual
Prefix:MR
First Name:TYRON
Middle Name:C
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 EASTON CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6628
Mailing Address - Country:US
Mailing Address - Phone:334-301-8277
Mailing Address - Fax:334-887-7435
Practice Address - Street 1:KROGER PHARMACY #260
Practice Address - Street 2:300 N DEAN RD.
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:334-821-1717
Practice Address - Fax:334-887-7435
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL104691835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10469OtherALA. ST. BD. PHARMACY