Provider Demographics
NPI:1598040966
Name:HORTMAN, BETHANY BAZE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:BAZE
Last Name:HORTMAN
Suffix:
Gender:F
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 1:5985 PEACHTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2818
Mailing Address - Country:US
Mailing Address - Phone:678-421-9599
Mailing Address - Fax:
Practice Address - Street 1:5985 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2818
Practice Address - Country:US
Practice Address - Phone:678-421-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist