Provider Demographics
NPI:1366971475
Name:BEASLEY, HEIDI SPENCER (RPH)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:SPENCER
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2042
Mailing Address - Country:US
Mailing Address - Phone:205-243-1830
Mailing Address - Fax:
Practice Address - Street 1:1600 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2410
Practice Address - Country:US
Practice Address - Phone:205-951-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12933OtherPHARMACIST LICENSE NUMBER