Provider Demographics
NPI:1811400476
Name:BAUTISTA, BETHEL JOY BAUTISTA
Entity Type:Individual
Prefix:
First Name:BETHEL JOY
Middle Name:BAUTISTA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6828 S PUGET SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4019
Mailing Address - Country:US
Mailing Address - Phone:206-229-4987
Mailing Address - Fax:
Practice Address - Street 1:6828 S PUGET SOUND AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4019
Practice Address - Country:US
Practice Address - Phone:206-229-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA30039334183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician