Provider Demographics
NPI:1144862905
Name:KEOWN, BEAU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BEAU
Middle Name:
Last Name:KEOWN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 FRONT ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1246
Mailing Address - Country:US
Mailing Address - Phone:360-354-1226
Mailing Address - Fax:360-354-6561
Practice Address - Street 1:1758 FRONT ST STE 106
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1246
Practice Address - Country:US
Practice Address - Phone:360-354-1226
Practice Address - Fax:360-354-6561
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60954156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist