Beau Landry Haden, PHARMD

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

E-09681 Issued in MS

Practice address

1109 Hwy 42
Sumrall, MS 39482

Phone

(601) 758-4243

Fax

(601) 758-4243

NPI assigned

Dec 11, 2020

Last updated

Dec 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sumrall Drug Store LLC

  dba Sumrall Drug Store

  • Community/Retail Pharmacy
  • Sumrall, MS
  • NPI 1275613952
  NPD Authorized official
• Sumrall Drug Store LLC

  dba Sumrall Drug Store Long Term Care

  • Long Term Care Pharmacy
  • Sumrall, MS
  • NPI 1366004731
  NPD

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1497351670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "394820120",
            "telephone_number": "601-758-4243",
            "fax_number": "601-758-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 HWY 42",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "39482",
            "telephone_number": "601-758-4243",
            "fax_number": "601-758-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADEN",
        "first_name": "BEAU",
        "middle_name": "LANDRY",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "E-09681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace E Dickerson, LMFT
• Susan L Dubose, FNP-BC
• Family Drug Mart of Sumrall, LLC (Family Drug Mart of Sumrall)
• Shelby Herndon Graves, COTA
• Codie Jaclyn Green
• Tasha F Haden, PHARMD
• Hattiesburg Clinic PA
• Hattiesburg Clinic, PA (Sumrall Physical Therapy)
• Clouzetta D Howze
• Rebecca Jameson, MD

• Community/Retail Pharmacy in Sumrall, MS
• Providers in Sumrall, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.