Beaumont Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BEAUMONT PHARMACY LLC

Doing business as

Malley's Family Pharmacy

Practice address

3110 Calder Ave.
Beaumont, TX 77702-1411

Phone

(409) 866-1429

Fax

(409) 866-3735

NPI assigned

Aug 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Trey Haney

Title

Manager

Phone

(409) 769-2406

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Malley's Family Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1124135538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 CALDER ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021411",
            "telephone_number": "409-866-1429",
            "fax_number": "409-866-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 CALDER AVE.",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021411",
            "telephone_number": "409-866-1429",
            "fax_number": "409-866-3735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUMONT PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2023-03-07",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "HANEY",
        "authorized_official_first_name": "TREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "409-769-2406"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF PHARMACY",
            "identifier": "25742",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149068",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malley's Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Malley's Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.