Provider Demographics
NPI:1780419028
Name:BEACH PHARMACY INC
Entity type:Organization
Organization Name:BEACH PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:228-896-7070
Mailing Address - Street 1:1110 COWAN RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-3441
Mailing Address - Country:US
Mailing Address - Phone:228-896-7070
Mailing Address - Fax:228-896-2843
Practice Address - Street 1:1110 COWAN RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3441
Practice Address - Country:US
Practice Address - Phone:228-896-7070
Practice Address - Fax:228-896-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy