MEDICARE: BEACH PROFESSIONAL PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1780412544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH PROFESSIONAL PHARMACY, INC.

Provider Business Mailing Address
First Line	:	12965 CRAWFORD DR
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-1041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17742 BEACH BLVD STE 100
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6847
Country	:	US
Telephone Number	:	714-848-4447
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASMINE HOANG-TRAN
Credential	:
Telephone Number	:	714-848-4447

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	07/23/2024

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