Provider Demographics
NPI:1386731537
Name:BEECHMONT PHARMACY, INC.
Entity type:Organization
Organization Name:BEECHMONT PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-338-3800
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-2902
Mailing Address - Country:US
Mailing Address - Phone:270-338-3800
Mailing Address - Fax:270-338-3807
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-2902
Practice Address - Country:US
Practice Address - Phone:270-338-3800
Practice Address - Fax:270-338-3807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1802922OtherNABP #
KYP06957OtherSTORE PERMIT #
KY084356OtherSALES TAX #
KY7100200020Medicaid
KYBG8835716OtherDEA LICENSE #
KY084356OtherSALES TAX #