| NPI | 1174677611 |
|---|---|
| Doing Business As | BEACON PORTAGE OUTPATIENT PHARMACY |
| Entity Type | Organization |
| Authorized Contact | JEFFREY PETER COSTELLO CFO 574-647-3460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301006331) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-11-26 |