Provider Demographics
NPI:1528200136
Name:BEACON PHARMACY, LLC
Entity Type:Organization
Organization Name:BEACON PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-518-8272
Mailing Address - Street 1:8607 ROBERTS DR STE 150-B
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2238
Mailing Address - Country:US
Mailing Address - Phone:770-709-0124
Mailing Address - Fax:
Practice Address - Street 1:8607 ROBERTS DR STE 150-B
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2238
Practice Address - Country:US
Practice Address - Phone:770-709-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0095713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy