Healthcare Provider Details

I. General information

NPI: 1598302119
Provider Name (Legal Business Name): BEACON HEALTH CARE SOLUTIONS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 BROADWAY AVE
NORTH BEND OR
97459-2216
US

IV. Provider business mailing address

2790 BROADWAY AVE
NORTH BEND OR
97459-2216
US

V. Phone/Fax

Practice location:
  • Phone: 541-808-0168
  • Fax:
Mailing address:
  • Phone: 541-808-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW THOMAS HIBBARD
Title or Position: PRESIDENT AND CEO
Credential: PHARM.D
Phone: 269-599-0857