Provider Demographics
NPI:1710226626
Name:BEACON PHARMACY LLC
Entity Type:Organization
Organization Name:BEACON PHARMACY LLC
Other - Org Name:ROCKVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ABHISHEK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-647-5729
Mailing Address - Street 1:40 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3501
Mailing Address - Country:US
Mailing Address - Phone:860-875-9263
Mailing Address - Fax:860-871-7142
Practice Address - Street 1:40 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3501
Practice Address - Country:US
Practice Address - Phone:860-875-9263
Practice Address - Fax:860-871-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00003583336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139335OtherPK
CT6996550001Medicare NSC