Provider Demographics
NPI:1528021375
Name:BEAM&PUTNAM INC
Entity Type:Organization
Organization Name:BEAM&PUTNAM INC
Other - Org Name:MOSS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-867-9611
Mailing Address - Street 1:701 W FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-3830
Mailing Address - Country:US
Mailing Address - Phone:704-867-9611
Mailing Address - Fax:704-864-7466
Practice Address - Street 1:701 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3830
Practice Address - Country:US
Practice Address - Phone:704-867-9611
Practice Address - Fax:704-864-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401205OtherNABP
NC0366129Medicaid
NC0366129Medicaid