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General NPI Number Information
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NPI Number | 1851317705
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Entity Type | Organization
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Legal Business Name | BEACON FALLS PHARMACY, LLC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 20 N MAIN ST
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City | BEACON FALLS
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State | CT
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Zip | 06403-1131
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Country | US
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Telephone | 203-729-4567
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Fax | 203-729-4573
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | BEACON FALLS
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State | CT
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Zip | 06403-0218
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Country | US
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Telephone | 203-729-4567
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Fax | 203-729-4573
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT BRADLEY
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Credential |
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Telephone | 203-729-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PCY2015
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License Number State | CT
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