Organization
BEACON HEALTH CARE SOLUTIONS INCORPORATED
Active
Other names
Broadway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW THOMAS HIBBARD PHARM.D (PRESIDENT AND CEO)
(269) 599-0857
Entity
Organization
Contact information
Practice address
2790 BROADWAY AVE, NORTH BEND, OR 97459-2216
(541) 808-0168
Mailing address
2790 BROADWAY AVE, NORTH BEND, OR 97459-2216
(541) 808-0168
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
333600000X
Pharmacy
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
Other
Enumeration date
12/02/2019
Last updated
10/13/2021
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