Provider Demographics
NPI:1588285282
Name:BEASLEY, ALEXANDER (CPHT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 BRITTANY PL
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-2992
Mailing Address - Country:US
Mailing Address - Phone:256-338-4410
Mailing Address - Fax:
Practice Address - Street 1:209 LAKESHORE PKWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-7105
Practice Address - Country:US
Practice Address - Phone:205-942-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT48071183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician