Provider Demographics
NPI:1205014255
Name:EOB II INC
Entity Type:Organization
Organization Name:EOB II INC
Other - Org Name:BEACON PRESCRIPTIONS KENSINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-839-5102
Mailing Address - Street 1:59 CHAMBERLAIN HWY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1920
Mailing Address - Country:US
Mailing Address - Phone:860-828-3921
Mailing Address - Fax:860-828-4165
Practice Address - Street 1:51-59 CHAMBERLAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037
Practice Address - Country:US
Practice Address - Phone:860-828-3921
Practice Address - Fax:860-828-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
CT00021053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008003236Medicaid
0721058OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0721058OtherNCPDP PROVIDER IDENTIFICATION NUMBER