Provider Demographics
NPI:1346285921
Name:BEAUCHAMP & O'ROURKE INC.
Entity Type:Organization
Organization Name:BEAUCHAMP & O'ROURKE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-775-4321
Mailing Address - Street 1:62 WOODSTOCK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3534
Mailing Address - Country:US
Mailing Address - Phone:802-775-4321
Mailing Address - Fax:802-775-8211
Practice Address - Street 1:62 WOODSTOCK AVE STE 1
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3534
Practice Address - Country:US
Practice Address - Phone:802-775-4321
Practice Address - Fax:802-775-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT03800005533336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0007170Medicaid
VT4700185OtherNABP
VT0007170Medicaid