Provider Demographics
NPI:1659655546
Name:BRUBAKER, BETH HEATHER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:HEATHER
Last Name:BRUBAKER
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 1:400 GOODYS LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1900
Mailing Address - Country:US
Mailing Address - Phone:865-288-5859
Mailing Address - Fax:865-288-5902
Practice Address - Street 1:400 GOODYS LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1900
Practice Address - Country:US
Practice Address - Phone:865-288-5859
Practice Address - Fax:865-288-5902
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036864183500000X
WVRP0007673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist