Provider Demographics
NPI:1780913954
Name:KISSEL, BETH ANN (RPH)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:KISSEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6430
Mailing Address - Country:US
Mailing Address - Phone:928-782-2529
Mailing Address - Fax:928-343-9219
Practice Address - Street 1:500 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6430
Practice Address - Country:US
Practice Address - Phone:928-782-2529
Practice Address - Fax:928-343-9219
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist