Provider Demographics
NPI:1487788428
Name:BEAUDREAULT, TAMMY SUE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:SUE
Last Name:BEAUDREAULT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAFEWAY 0405 PHARMACY
Mailing Address - Street 2:3627 AIRPORT WAY
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709
Mailing Address - Country:US
Mailing Address - Phone:907-374-4060
Mailing Address - Fax:907-374-4019
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5907
Practice Address - Country:US
Practice Address - Phone:907-458-5615
Practice Address - Fax:907-458-5060
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1645OtherPHARMACIST LICENSE