Provider Demographics
NPI:1043598667
Name:SUNDAHL, BETH J (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:J
Last Name:SUNDAHL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2519
Mailing Address - Country:US
Mailing Address - Phone:605-342-8505
Mailing Address - Fax:605-342-8903
Practice Address - Street 1:730 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2519
Practice Address - Country:US
Practice Address - Phone:605-342-8505
Practice Address - Fax:605-342-8903
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18491183500000X
SDR5984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist