Provider Demographics
NPI:1881653525
Name:BEAM AND WORLEY INC
Entity Type:Organization
Organization Name:BEAM AND WORLEY INC
Other - Org Name:BLUE RIDGE PHARMACY NORTHPARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD RPH
Authorized Official - Phone:336-667-6484
Mailing Address - Street 1:23 SPARTA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:N WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3185
Mailing Address - Country:US
Mailing Address - Phone:336-667-6484
Mailing Address - Fax:336-838-9597
Practice Address - Street 1:23 SPARTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3185
Practice Address - Country:US
Practice Address - Phone:336-667-6484
Practice Address - Fax:336-838-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC051643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0975367Medicaid
2069273OtherPK
NC0975367Medicaid