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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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