Provider Demographics
NPI:1851674527
Name:HUSTON, BETHANIE ANN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:ANN
Last Name:HUSTON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2937
Mailing Address - Country:US
Mailing Address - Phone:507-369-0260
Mailing Address - Fax:507-369-0266
Practice Address - Street 1:703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2937
Practice Address - Country:US
Practice Address - Phone:507-369-0260
Practice Address - Fax:507-369-0266
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist