Basic Information
| Provider Information | |||||||||
| NPI: | 1659481976 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEACH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH.,PHARMD. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 33 RITTER RD | ||||||||
| Address2: | |||||||||
| City: | STORMVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125825312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452271421 | ||||||||
| FaxNumber: | 8452271421 | ||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 9147884380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 39831-1 | NY | X | Pharmacy Service Providers | Pharmacist | 1835P1200X | 39831-1 | NY | X | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.