Provider Demographics
NPI:1609155159
Name:BETHEA, JOHNNY JAMES II (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:JAMES
Last Name:BETHEA
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 MARENA PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-9202
Mailing Address - Country:US
Mailing Address - Phone:919-682-6668
Mailing Address - Fax:919-530-7968
Practice Address - Street 1:1010 SYNC ST STE 100
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5473
Practice Address - Country:US
Practice Address - Phone:919-439-5529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7994183500000X
NC13264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist