Provider Demographics
NPI:1760041545
Name:BEAULIEU, NANCY JANE (BS PHARM, BCOP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JANE
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:BS PHARM, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LUNAR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2320
Mailing Address - Country:US
Mailing Address - Phone:203-640-3991
Mailing Address - Fax:
Practice Address - Street 1:19 LUNAR DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2320
Practice Address - Country:US
Practice Address - Phone:203-640-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70301835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology