Provider Demographics
NPI:1497954283
Name:MADDY, BETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MADDY
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 1:3330 MARKTIN LUTHER KING JR PKWY
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5672
Mailing Address - Country:US
Mailing Address - Phone:515-255-6213
Mailing Address - Fax:
Practice Address - Street 1:3330 MARKTIN LUTHER KING JR PKWY
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5672
Practice Address - Country:US
Practice Address - Phone:515-255-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1614571OtherNABP
IA0233916Medicaid
IA0233916Medicaid
IA1614571OtherNABP