Provider Demographics
NPI:1679577498
Name:BECKMANS GREENE STREET PHARMACY INC
Entity Type:Organization
Organization Name:BECKMANS GREENE STREET PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:301-777-7336
Mailing Address - Street 1:686 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2734
Mailing Address - Country:US
Mailing Address - Phone:301-777-7336
Mailing Address - Fax:301-777-3860
Practice Address - Street 1:686 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2734
Practice Address - Country:US
Practice Address - Phone:301-777-7336
Practice Address - Fax:301-777-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MDP009393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112011OtherNCPDP NUMBER
4434060002Medicare NSC