Provider Demographics
NPI:1417954157
Name:BAGWELL, BETH ANNETTE (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANNETTE
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 BEECH LN
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3024
Mailing Address - Country:US
Mailing Address - Phone:806-688-0148
Mailing Address - Fax:806-665-7226
Practice Address - Street 1:1420 N HOBART ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4124
Practice Address - Country:US
Practice Address - Phone:806-665-7642
Practice Address - Fax:806-665-7226
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist