Healthcare Provider Details

I. General information

NPI: 1407908783
Provider Name (Legal Business Name): BEACON PRESCRIPTIONS TERRYVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MAIN ST
TERRYVILLE CT
06786-5910
US

IV. Provider business mailing address

241 MAIN ST
TERRYVILLE CT
06786-5910
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-5158
  • Fax: 860-589-8699
Mailing address:
  • Phone: 860-585-5158
  • Fax: 860-589-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1399
License Number StateCT

VIII. Authorized Official

Name: TIMOTHY DANIEL MURAWSKI
Title or Position: PHARMACIST
Credential: R. PH.
Phone: 860-585-5158