Provider Demographics
NPI:1760107403
Name:HERVEY & BETHARD INC.
Entity Type:Organization
Organization Name:HERVEY & BETHARD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-758-8286
Mailing Address - Street 1:1900 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-3299
Mailing Address - Country:US
Mailing Address - Phone:903-758-8286
Mailing Address - Fax:
Practice Address - Street 1:1900 S HIGH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-3299
Practice Address - Country:US
Practice Address - Phone:903-758-8286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091645401Medicaid