1720145097 NPI number — BEAVER PHARMACY LLC

Table of content: (NPI 1720145097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720145097 NPI number — BEAVER PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAVER PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720145097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7046 STATE RD 335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7046 STATE RD 335
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-226-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCBEE
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
Authorized Official Title or Position:
RPH
Authorized Official Telephone Number:
740-226-5000

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3675494 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".