MEDICARE: BEACON HEALTH CARE SOLUTIONS INCORPORATED

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	291U00000X	Clinical Medical Laboratory
2	3336C0002X	Clinic Pharmacy
3	3336C0003X	Community/Retail Pharmacy
4	3336C0004X	Compounding Pharmacy
5	333600000X	Pharmacy

General Provider Information

NPI Number	:	1598302119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON HEALTH CARE SOLUTIONS INCORPORATED

Provider Business Mailing Address
First Line	:	2790 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2216
Country	:	US
Telephone Number	:	541-808-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	2790 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2216
Country	:	US
Telephone Number	:	541-808-0168
Fax Number	:

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

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	10/13/2021

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