Healthcare Provider Details

I. General information

NPI: 1114001955
Provider Name (Legal Business Name): BEACH RX, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41934 HWY 12
AVON NC
27915
US

IV. Provider business mailing address

P.O. BOX 660
AVON NC
27915
US

V. Phone/Fax

Practice location:
  • Phone: 252-995-3811
  • Fax: 252-995-7955
Mailing address:
  • Phone: 252-995-3811
  • Fax: 252-995-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number04503
License Number StateNC

VIII. Authorized Official

Name: MATTHEW THORNBROUGH
Title or Position: PRESIDENT/PHARMACIST
Credential:
Phone: 529-995-3811