Provider Demographics
NPI:1679912307
Name:COPPERIDGE, BETHANY MEKENZIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:MEKENZIE
Last Name:COPPERIDGE
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 1:1101 FOREST RETREAT RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2272
Mailing Address - Country:US
Mailing Address - Phone:615-348-3258
Mailing Address - Fax:615-349-3249
Practice Address - Street 1:1101 FOREST RETREAT RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2272
Practice Address - Country:US
Practice Address - Phone:615-348-3258
Practice Address - Fax:615-348-3249
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20650183500000X
GARPH031128183500000X
TN375581835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist