Provider Demographics
NPI:1295855799
Name:BEAM & PUTNAM INC.
Entity Type:Organization
Organization Name:BEAM & PUTNAM INC.
Other - Org Name:MOSSDRUGSTORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:704-867-9611
Mailing Address - Street 1:701 W FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-3830
Mailing Address - Country:US
Mailing Address - Phone:704-867-9611
Mailing Address - Fax:704-864-7466
Practice Address - Street 1:701 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3830
Practice Address - Country:US
Practice Address - Phone:704-867-9611
Practice Address - Fax:704-864-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07051332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0366129Medicaid
NC0366129Medicaid
NC2801246Medicare PIN