Healthcare Provider Details

I. General information

NPI: 1144460718
Provider Name (Legal Business Name): BEATTIES COMMUNITY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 VILLAGE VISTA DR STE 100
ERIE CO
80516-2527
US

IV. Provider business mailing address

3140 VILLAGE VISTA DR STE 100
ERIE CO
80516-2527
US

V. Phone/Fax

Practice location:
  • Phone: 720-890-5095
  • Fax: 720-890-4343
Mailing address:
  • Phone: 720-890-5095
  • Fax: 720-890-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPDO761
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPDO 761
License Number StateCO

VIII. Authorized Official

Name: MR. LYAL S BEATTIE III
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 720-890-5095