Active NPI
Justin Beasley
- Pharmacist
- La Crosse, WI
National Provider Identifier
1770116352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19657-40
- Practice address
- 4415 State Road 16
La Crosse, WI 54601-1815 - Phone
- (608) 779-0939
- NPI assigned
- Feb 21, 2020
- Last updated
- Feb 21, 2020
- Sex
- Male
- 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 | 19657-40 | WI | Primary |
Addresses
Primary practice location
4415 State Road 16
La Crosse, WI 54601-1815
Mailing address
4415 State Road 16
La Crosse, WI 54601-1815
Phone (608) 779-0939
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19657-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
4415 State Road 16
La Crosse, WI 54601
Phone (608) 317-9220
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582243200000",
"number": "1770116352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4415 STATE ROAD 16",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546011815",
"telephone_number": "608-779-0939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4415 STATE ROAD 16",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546011815",
"telephone_number": "608-779-0939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEASLEY",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-21",
"last_updated": "2020-02-21",
"certification_date": "2020-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "19657-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.