Provider Demographics
NPI:1881624195
Name:BECKWITH, BRUCE ERIC (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ERIC
Last Name:BECKWITH
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 1:655 NW GREENWOOD AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1533
Mailing Address - Country:US
Mailing Address - Phone:541-923-3822
Mailing Address - Fax:541-923-8754
Practice Address - Street 1:655 NW GREENWOOD AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1533
Practice Address - Country:US
Practice Address - Phone:541-923-3822
Practice Address - Fax:541-923-8754
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080218Medicaid
OR080218Medicaid