Provider Demographics
NPI:1952416992
Name:BEACH RX, INC.
Entity Type:Organization
Organization Name:BEACH RX, INC.
Other - Org Name:BEACH PHARMACY OF HATTERAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-986-2400
Mailing Address - Street 1:P.O. BOX 428
Mailing Address - Street 2:
Mailing Address - City:HATTERAS
Mailing Address - State:NC
Mailing Address - Zip Code:27943
Mailing Address - Country:US
Mailing Address - Phone:252-986-2400
Mailing Address - Fax:252-986-5363
Practice Address - Street 1:57353 NC HIGHWAY 12
Practice Address - Street 2:TAMS PLAZA
Practice Address - City:HATTERAS
Practice Address - State:NC
Practice Address - Zip Code:27943-0428
Practice Address - Country:US
Practice Address - Phone:252-986-2400
Practice Address - Fax:252-986-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC053133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0285221Medicaid
2070275OtherPK
0890270001Medicare NSC
3427843OtherOTHER ID NUMBER-COMMERCIAL NUMBER