Provider Demographics
NPI:1528809886
Name:GOLD BEACH PHARMACY LLC
Entity type:Organization
Organization Name:GOLD BEACH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:269-599-0857
Mailing Address - Street 1:2790 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2216
Mailing Address - Country:US
Mailing Address - Phone:541-727-3300
Mailing Address - Fax:541-919-0034
Practice Address - Street 1:94202 2ND ST
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-9700
Practice Address - Country:US
Practice Address - Phone:541-727-3300
Practice Address - Fax:541-919-0034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACON HEALTH CARE SOLUTIONS INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-03
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy