Provider Demographics
NPI:1649383092
Name:LBITTEL
Entity Type:Organization
Organization Name:LBITTEL
Other - Org Name:BEACON PRESCRIPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-559-4217
Mailing Address - Street 1:294 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098
Mailing Address - Country:US
Mailing Address - Phone:860-738-2506
Mailing Address - Fax:860-379-3876
Practice Address - Street 1:294 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098
Practice Address - Country:US
Practice Address - Phone:860-738-2506
Practice Address - Fax:860-379-3876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
CTPCY.00017193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004127412Medicaid
CT008107659Medicaid
2000252OtherPK
CT008106469Medicaid
CT004123634Medicaid
CT332B00000XOtherDURABLE MEDICAL EQUIP