Organization
BEACON HEALTH VENTURES INC
Active
Other names
Beacon HC Pharmacy ELK
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY CONRAD (PRESIDENT)
(574) 647-8777
Entity
Organization
Contact information
Practice address
5155 VERDANT ST, ELKHART, IN 46516-9315
(574) 524-7582
(574) 524-7597
Mailing address
3355 DOUGLAS RD, SUITE 100, SOUTH BEND, IN 46635-1781
(574) 647-8731
(574) 647-8768
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100301140C
—
IN
01
—
2158807
PK
—
Enumeration date
06/19/2012
Last updated
02/27/2017
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