Provider Demographics
NPI:1164137782
Name:HUSTED, BETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:HUSTED
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 1:4483 BROADLEY CIR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6958
Mailing Address - Country:US
Mailing Address - Phone:330-312-8403
Mailing Address - Fax:
Practice Address - Street 1:7167 KECK PARK CIR NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-6301
Practice Address - Country:US
Practice Address - Phone:330-498-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist