MEDICARE: BEACON FALLS PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PCY2015	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2002743	OTHER		PK

General Provider Information

NPI Number	:	1851317705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON FALLS PHARMACY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	BEACON FALLS
State	:	CT
Zip	:	06403-0218
Country	:	US
Telephone Number	:	203-729-4567
Fax Number	:	203-729-4573

Provider Business Practice Location Address
First Line	:	20 N MAIN ST
Second Line	:
City	:	BEACON FALLS
State	:	CT
Zip	:	06403-1131
Country	:	US
Telephone Number	:	203-729-4567
Fax Number	:	203-729-4573

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT BRADLEY
Credential	:
Telephone Number	:	203-729-4567

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/18/2017

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