Healthcare Provider Details

I. General information

NPI: 1861436487
Provider Name (Legal Business Name): DAVID J BEACH PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL, CAMP PENDLETON BLDG H-100 SANTA MARGARITA ROAD
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

NAVAL HOSPITAL, CAMP PENDLETON BLDG H-100 SANTA MARGARITA ROAD
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1287
  • Fax: 760-725-1267
Mailing address:
  • Phone: 760-725-1287
  • Fax: 760-725-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4934
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: