Provider Demographics
NPI:1659606952
Name:BELL, BETHANY MAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MAE
Last Name:BELL
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 1:161 W HACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4012
Mailing Address - Country:US
Mailing Address - Phone:602-770-3893
Mailing Address - Fax:
Practice Address - Street 1:87 E WILLIAMS FIELD RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5202
Practice Address - Country:US
Practice Address - Phone:480-726-3813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS016265OtherPHARMACY LICENSE