# JONATHAN BEASLEY PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Beasley's Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073057535
- **Authorized official:** JONATHAN BEASLEY (OWNER)
- **Authorized official phone:** (205) 695-0144

## Contact information

- **Practice address:** 170 5TH ST SW, VERNON, AL 35592-5215
- **Practice address phone:** (205) 695-0144
- **Practice address fax:** (205) 695-0139
- **Mailing address:** PO BOX 456, VERNON, AL 35592-0456
- **Mailing address phone:** (205) 695-0144
- **Mailing address fax:** (205) 695-0139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 114683 | AL | Yes |

## Other

- **Enumeration date:** 12/16/2016
- **Last updated:** 04/24/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 196440 | — | AL |
| 01 | — | 2167011 | PK | — |