Provider Demographics
NPI:1689033847
Name:BETHUNE, ANTHONY DAWSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAWSON
Last Name:BETHUNE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7748 SENJILL CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8758
Mailing Address - Country:US
Mailing Address - Phone:321-438-1084
Mailing Address - Fax:
Practice Address - Street 1:7748 SENJILL CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8758
Practice Address - Country:US
Practice Address - Phone:321-438-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS34976Medicaid
FLPS34976Medicaid
FLPS34976Medicare UPIN
FLPS34976Medicare PIN