Provider Demographics
NPI:1346346640
Name:BEACH PHARMACIST INC
Entity Type:Organization
Organization Name:BEACH PHARMACIST INC
Other - Org Name:NORTHSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOLLIE
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-449-3325
Mailing Address - Street 1:6105 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2372
Mailing Address - Country:US
Mailing Address - Phone:843-449-3325
Mailing Address - Fax:843-449-6680
Practice Address - Street 1:6105 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2372
Practice Address - Country:US
Practice Address - Phone:843-449-3325
Practice Address - Fax:843-449-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5002435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty