Provider Demographics
NPI:1356338370
Name:FEDUTES HENDERSON, BETHANY A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:A
Last Name:FEDUTES HENDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:460 BOW STREET
Mailing Address - City:STOCKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15483-0304
Mailing Address - Country:US
Mailing Address - Phone:724-938-0993
Mailing Address - Fax:
Practice Address - Street 1:460 BOW STREET
Practice Address - Street 2:
Practice Address - City:STOCKDALE
Practice Address - State:PA
Practice Address - Zip Code:15483
Practice Address - Country:US
Practice Address - Phone:412-582-5563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist