NPIMap

Organization Active NPI

Beam and Blizzard LLC

Doing business as Indian Trail Pharmacy

  • Community/Retail Pharmacy
  • Indian Trail, NC
National Provider Identifier
1740374974
Registry record updated Nov 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
11558 Issued in NC
Legal business name
BEAM AND BLIZZARD LLC
Doing business as
Indian Trail Pharmacy
Practice address
106 Indian Trail Rd S
Indian Trail, NC 28079-9669
Phone
(704) 821-7617
Fax
(704) 821-0177
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terry DevineNPI 1528350626
Title
Manager
Phone
(704) 821-7617

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 11558 NC Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

106 Indian Trail Rd S
Indian Trail, NC 28079-9669

Mailing address

106 Indian Trail Rd S
Indian Trail, NC 28079-9669
Phone (704) 821-7617

Other identifiers 2

IdentifierTypeStateIssuer
0905117MedicaidNC
2140464OtherPK

Other names 1

  • Indian Trail Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140123000201 NC DME Supplier - Pharmacy 5193953065 Practice locations: Indian Trail, NC
O20141104002313 NC Part B Supplier - Mass Immunization (Roster Biller Only) 5193953065 Practice locations: Indian Trail, NC

National Provider Directory

National Provider Directory
Tax ID family
Beam and Blizzard LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415577600000",
    "number": "1740374974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 INDIAN TRAIL RD S",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280799669",
            "telephone_number": "704-821-7617",
            "fax_number": "704-821-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 INDIAN TRAIL RD S",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280799669",
            "telephone_number": "704-821-7617",
            "fax_number": "704-821-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAM AND BLIZZARD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-11-10",
        "status": "A",
        "authorized_official_last_name": "DEVINE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "704-821-7617"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "11558",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0905117",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140464",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Trail Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indian Trail, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.