Provider Demographics
NPI:1891071999
Name:BARTH, MARY BETH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:BARTH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:106 BEDROCK DR
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-9565
Mailing Address - Country:US
Mailing Address - Phone:865-748-3080
Mailing Address - Fax:
Practice Address - Street 1:106 BEDROCK DR
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-9565
Practice Address - Country:US
Practice Address - Phone:865-748-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist