Provider Demographics
NPI:1659475614
Name:BEAM & FLYNN INC
Entity Type:Organization
Organization Name:BEAM & FLYNN INC
Other - Org Name:WINGARDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:864-223-6120
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-0660
Mailing Address - Country:US
Mailing Address - Phone:864-223-6120
Mailing Address - Fax:864-223-0693
Practice Address - Street 1:202 SEABOARD AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2201
Practice Address - Country:US
Practice Address - Phone:864-223-6120
Practice Address - Fax:864-223-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC500098873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087922OtherPK
SC798875Medicaid