Provider Demographics
NPI:1124361589
Name:NORTH BEACH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:NORTH BEACH ENTERPRISES, INC.
Other - Org Name:SHORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-965-3036
Mailing Address - Street 1:501 LASKIN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3901
Mailing Address - Country:US
Mailing Address - Phone:757-965-3036
Mailing Address - Fax:757-965-3039
Practice Address - Street 1:3271B MAIN ST.
Practice Address - Street 2:
Practice Address - City:EXMORE
Practice Address - State:VA
Practice Address - Zip Code:23350-3901
Practice Address - Country:US
Practice Address - Phone:757-442-7982
Practice Address - Fax:757-442-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy