Provider Demographics
NPI:1386198745
Name:BEECHMONT PHARMACY INC
Entity Type:Organization
Organization Name:BEECHMONT PHARMACY INC
Other - Org Name:GREENVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-754-4300
Mailing Address - Street 1:117 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-2902
Mailing Address - Country:US
Mailing Address - Phone:270-338-3800
Mailing Address - Fax:270-338-3807
Practice Address - Street 1:117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-2902
Practice Address - Country:US
Practice Address - Phone:270-338-3800
Practice Address - Fax:270-338-3807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP069573336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163601OtherPK