Active NPI
Tammy Sue Beaudreault, PHARMD
- Pharmacist
- Fairbanks, AK
National Provider Identifier
1487788428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 1645
- Practice address
- 1650 Cowles St
Fairbanks, AK 99701-5907 - Phone
- (907) 458-5615
- Fax
- (907) 458-5060
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 1645 | AK | Primary |
Addresses
Primary practice location
1650 Cowles St
Fairbanks, AK 99701-5907
Mailing address
Safeway 0405 Pharmacy
3627 Airport Way
Fairbanks, AK 99709
Phone (907) 374-4060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1645 | Other | AK | PHARMACIST LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1645 | AK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611619200000",
"number": "1487788428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "SAFEWAY 0405 PHARMACY",
"address_2": "3627 AIRPORT WAY",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "99709",
"telephone_number": "907-374-4060",
"fax_number": "907-374-4019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 COWLES ST",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015907",
"telephone_number": "907-458-5615",
"fax_number": "907-458-5060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAUDREAULT",
"first_name": "TAMMY",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2021-01-26",
"certification_date": "2021-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AK",
"license": "1645",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "1645",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.