Organization
BEAM & MANUS INC
Active
Organization
BEAM & MANUS INC
Active
Other names
BLUE RIDGE PHARMACY MIDTOWN
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH KOONTZ RPH (PIC AND OWNER)
(336) 838-3782
Entity
Organization
Contact information
Practice address
306 WILKESBORO AVE, N WILKESBORO, NC 28659-4228
(336) 838-3782
(336) 838-2432
Mailing address
306 WILKESBORO AVE, N WILKESBORO, NC 28659-4228
(336) 838-3782
(336) 838-2432
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
04955
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0511620001
—
NC
05
—
0975300
—
NC
01
—
2067611
PK
—
Enumeration date
09/13/2006
Last updated
01/17/2017
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