Provider Demographics
NPI:1114001955
Name:BEACH RX, INC.
Entity Type:Organization
Organization Name:BEACH RX, INC.
Other - Org Name:BEACH PHARMACY OF AVON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:529-995-3811
Mailing Address - Street 1:P.O. BOX 660
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NC
Mailing Address - Zip Code:27915
Mailing Address - Country:US
Mailing Address - Phone:252-995-3811
Mailing Address - Fax:252-995-7955
Practice Address - Street 1:41934 HWY 12
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NC
Practice Address - Zip Code:27915
Practice Address - Country:US
Practice Address - Phone:252-995-3811
Practice Address - Fax:252-995-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NC045033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2069219OtherPK
NC0285148Medicaid