Provider Demographics
NPI:1265820799
Name:BETHELVIEW PHARMACY, LLC
Entity Type:Organization
Organization Name:BETHELVIEW PHARMACY, LLC
Other - Org Name:BETHELVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-253-4893
Mailing Address - Street 1:2336 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6370
Mailing Address - Country:US
Mailing Address - Phone:470-253-4893
Mailing Address - Fax:470-253-4894
Practice Address - Street 1:2336 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6370
Practice Address - Country:US
Practice Address - Phone:470-253-4893
Practice Address - Fax:470-253-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy