Provider Demographics
NPI:1285914440
Name:BEASLEY, LENWARDE PAUL (BS)
Entity type:Individual
Prefix:MR
First Name:LENWARDE
Middle Name:PAUL
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12561 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3071
Mailing Address - Country:US
Mailing Address - Phone:303-457-8355
Mailing Address - Fax:303-457-8355
Practice Address - Street 1:2870 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6618
Practice Address - Country:US
Practice Address - Phone:303-758-5384
Practice Address - Fax:303-758-5389
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist