Organization
BEACON HEALTH VENTURES, INC
Active
Organization
BEACON HEALTH VENTURES, INC
Active
Other names
Beacon HC Pharm SB
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG CONRAD (VICE PRESIDENT)
(574) 647-8777
Entity
Organization
Contact information
Practice address
3355 DOUGLAS RD, SOUTH BEND, IN 46635
(574) 647-2273
Mailing address
3355 DOUGLAS RD, SUITE 400, SOUTH BEND, IN 46635-1781
(574) 647-2273
(574) 647-8764
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0004X
Compounding Pharmacy
—
IN
3336H0001X
Home Infusion Therapy Pharmacy
Primary
60004143A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000097412
ANTHEM
—
05
—
100301140A
—
IN
Enumeration date
10/01/2013
Last updated
06/17/2016
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