Provider Demographics
NPI:1407908783
Name:BEACON PRESCRIPTIONS TERRYVILLE
Entity Type:Organization
Organization Name:BEACON PRESCRIPTIONS TERRYVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MURAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:860-585-5158
Mailing Address - Street 1:241 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TERRYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06786-5910
Mailing Address - Country:US
Mailing Address - Phone:860-585-5158
Mailing Address - Fax:860-589-8699
Practice Address - Street 1:241 MAIN ST
Practice Address - Street 2:
Practice Address - City:TERRYVILLE
Practice Address - State:CT
Practice Address - Zip Code:06786-5910
Practice Address - Country:US
Practice Address - Phone:860-585-5158
Practice Address - Fax:860-589-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0713760OtherNABP
CT5012552OtherCONNPACE