Provider Demographics
NPI:1962637017
Name:BETEL, EDWARD ISAAC (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ISAAC
Last Name:BETEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1534
Mailing Address - Country:US
Mailing Address - Phone:248-676-2916
Mailing Address - Fax:
Practice Address - Street 1:640 N MILFORD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1534
Practice Address - Country:US
Practice Address - Phone:248-676-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist