Provider Demographics
NPI:1144460718
Name:BEATTIES COMMUNITY PHARMACY LLC
Entity type:Organization
Organization Name:BEATTIES COMMUNITY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LYAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEATTIE
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:720-890-5095
Mailing Address - Street 1:3140 VILLAGE VISTA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2527
Mailing Address - Country:US
Mailing Address - Phone:720-890-5095
Mailing Address - Fax:720-890-4343
Practice Address - Street 1:3140 VILLAGE VISTA DR
Practice Address - Street 2:STE 100
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2527
Practice Address - Country:US
Practice Address - Phone:720-890-5095
Practice Address - Fax:720-890-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPDO 7613336C0004X
COPDO7613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7154360001Medicare NSC