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BEAM AND BLIZZARD LLC NPI 1407252745


NPI Information

NPI: 1407252745
Provider Name: BEAM AND BLIZZARD, LLC

Doing Business As: INDIAN TRAIL PHARMACY

Classification: Pharmacy - 333600000X
Entity Type: Organization
Address:
106 INDIAN TRAIL RD S
INDIAN TRAIL, NC
ZIP 28079
Phone: (704) 821-7617
Get Directions

BEAM AND BLIZZARD, LLC is a pharmacy in Indian Trail, NC. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. BEAM AND BLIZZARD, LLC NPI is 1407252745. The provider is registered as an organization entity type.
The provider Is Doing Business As Indian Trail Pharmacy.

The provider's business location address is:

106 INDIAN TRAIL RD S
INDIAN TRAIL, NC
ZIP 28079-669
Phone: (704) 821-7617
Fax: (704) 821-0177

The provider's authorized official is Terry A Devine .
The authorized official title is Pharmacy Manager and has the following contact phone number (704) 821-7617.

The enumeration date for this NPI number is 11/14/2014 and was last updated on 12/1/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacy11558NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10905117MEDICAIDNORTH CAROLINA
26973150001OTHERNORTH CAROLINAMEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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