Provider Demographics
NPI:1962440859
Name:BEAM & WEASE OF KINGS MOUNTAIN INC
Entity Type:Organization
Organization Name:BEAM & WEASE OF KINGS MOUNTAIN INC
Other - Org Name:KM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:704-739-1698
Mailing Address - Street 1:1106 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-2742
Mailing Address - Country:US
Mailing Address - Phone:704-739-1698
Mailing Address - Fax:704-739-4248
Practice Address - Street 1:1106 SHELBY RD
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2742
Practice Address - Country:US
Practice Address - Phone:704-739-1698
Practice Address - Fax:704-739-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC080393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065961OtherPK
NC0235855Medicaid
NC0235855Medicaid
2065961OtherPK