Provider Demographics
NPI:1568744621
Name:BEACH, MATTHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:BEACH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 E SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9728
Mailing Address - Country:US
Mailing Address - Phone:317-887-0934
Mailing Address - Fax:317-887-0970
Practice Address - Street 1:6745 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9728
Practice Address - Country:US
Practice Address - Phone:317-887-0934
Practice Address - Fax:317-887-0970
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019639A183500000X
AZS011179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist