Provider Demographics
NPI:1285939058
Name:BEACH PHARMACY, INC
Entity type:Organization
Organization Name:BEACH PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-239-3066
Mailing Address - Street 1:1364 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4623
Mailing Address - Country:US
Mailing Address - Phone:305-945-2818
Mailing Address - Fax:786-472-6868
Practice Address - Street 1:1364 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4623
Practice Address - Country:US
Practice Address - Phone:305-945-2818
Practice Address - Fax:786-472-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH25209333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy