Provider Demographics
NPI:1356030480
Name:BETHEA BROTHERS DRUG CO INC
Entity type:Organization
Organization Name:BETHEA BROTHERS DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-673-2691
Mailing Address - Street 1:218 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-4355
Mailing Address - Country:US
Mailing Address - Phone:870-673-2691
Mailing Address - Fax:870-673-2651
Practice Address - Street 1:218 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-4355
Practice Address - Country:US
Practice Address - Phone:870-673-2691
Practice Address - Fax:870-673-2651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHEA BROS DRUG CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy