Provider Demographics
NPI:1790198745
Name:SAWYERS, BETHANY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SAWYERS
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 1:150 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2029
Mailing Address - Country:US
Mailing Address - Phone:276-245-5648
Mailing Address - Fax:276-227-0203
Practice Address - Street 1:150 N 11TH ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2029
Practice Address - Country:US
Practice Address - Phone:276-245-5648
Practice Address - Fax:276-227-0203
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211483183500000X
WVRP0008034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0008034OtherWEST VIRGINIA BOARD OF PHARMACY
VA0202211483OtherVIRGINIA BOARD OF PHARMACY