Provider Demographics
NPI:1770702359
Name:BEAUMONT, COURTNEY J (RPH)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:J
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:J
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:500 COUNTY ROAD 1225 E
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IL
Mailing Address - Zip Code:62468-4137
Mailing Address - Country:US
Mailing Address - Phone:217-246-1058
Mailing Address - Fax:
Practice Address - Street 1:101 S MERCHANT ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2425
Practice Address - Country:US
Practice Address - Phone:217-342-4301
Practice Address - Fax:217-347-5597
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist