Provider Demographics
NPI:1508285131
Name:DEGROFF RX LLC
Entity Type:Organization
Organization Name:DEGROFF RX LLC
Other - Org Name:BEACON PRESCRIPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-225-6487
Mailing Address - Street 1:543 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3915
Mailing Address - Country:US
Mailing Address - Phone:860-225-6487
Mailing Address - Fax:860-229-4488
Practice Address - Street 1:543 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3915
Practice Address - Country:US
Practice Address - Phone:860-225-6487
Practice Address - Fax:860-229-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
CTPCY00003323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146882OtherPK
CT008050853Medicaid
2146882OtherPK