Provider Demographics
NPI:1447240361
Name:BETHEA, JAMES WAYNE JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WAYNE
Last Name:BETHEA
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 HEMME RD
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-2957
Mailing Address - Country:US
Mailing Address - Phone:870-673-2036
Mailing Address - Fax:
Practice Address - Street 1:218 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-4355
Practice Address - Country:US
Practice Address - Phone:870-673-2691
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR8072OtherPHARMACISTS LICENCE