Organization
EOB II INC
Active
Other names
BEACON PRESCRIPTIONS KENSINGTON
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LOVELAND RPH (OWNER)
(860) 839-5102
Entity
Organization
Contact information
Practice address
51-59 CHAMBERLAN HIGHWAY, KENSINGTON, CT 06037
(860) 828-3921
(860) 828-4165
Mailing address
59 CHAMBERLAIN HWY, KENSINGTON, CT 06037-1920
(860) 828-3921
(860) 828-4165
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0002105
CT
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008003236
—
CT
01
—
0721058
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/01/2008
Last updated
11/07/2011
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