Provider Demographics
NPI:1033141528
Name:GAB PRESCRIPTIONS INC
Entity Type:Organization
Organization Name:GAB PRESCRIPTIONS INC
Other - Org Name:BEACON PRESCRIPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-589-5587
Mailing Address - Street 1:25 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3893
Mailing Address - Country:US
Mailing Address - Phone:860-589-5587
Mailing Address - Fax:860-584-8574
Practice Address - Street 1:25 COLLINS RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3893
Practice Address - Country:US
Practice Address - Phone:860-589-5587
Practice Address - Fax:860-584-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CT10163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1998115OtherPK
CT004031514Medicaid
1998115OtherPK