Provider Demographics
NPI:1033202700
Name:HERVEY & BETHARD INC.
Entity Type:Organization
Organization Name:HERVEY & BETHARD INC.
Other - Org Name:DBA LOUIS MORGAN DRUG #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-758-8286
Mailing Address - Street 1:1900 S. HIGH ST.
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602
Mailing Address - Country:US
Mailing Address - Phone:903-758-8286
Mailing Address - Fax:903-758-2728
Practice Address - Street 1:1900 S. HIGH ST.
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602
Practice Address - Country:US
Practice Address - Phone:903-758-8286
Practice Address - Fax:903-758-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01373332B00000X, 3336C0003X, 3336L0003X
TX1373332B00000X, 3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148388Medicaid
TX4525753OtherNCPDP PROVIDER ID
TX120579Medicaid
TX4525753OtherNCPDP PROVIDER ID