Provider Demographics
NPI:1144734054
Name:BEECHMONT PHARMACY, INC.
Entity type:Organization
Organization Name:BEECHMONT PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CPA/ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:POWERS
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:270-684-3414
Mailing Address - Street 1:3403 MARYCREST DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6073
Mailing Address - Country:US
Mailing Address - Phone:270-314-5440
Mailing Address - Fax:270-240-4248
Practice Address - Street 1:2025 W EVERLY BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5401
Practice Address - Country:US
Practice Address - Phone:270-377-0123
Practice Address - Fax:270-377-0126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEECHMONT PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP078363336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFC7203134OtherDEA LICENSE