Provider Demographics
NPI:1134577273
Name:BEECHER RX LLC
Entity type:Organization
Organization Name:BEECHER RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHBOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-337-1121
Mailing Address - Street 1:3169 BEECHER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3169 BEECHER RD STE 102
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-337-1121
Practice Address - Fax:810-963-0417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEECHER RX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-31
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy