Provider Demographics
NPI:1801177001
Name:O'NEAL, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7780 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8262
Mailing Address - Country:US
Mailing Address - Phone:321-254-1072
Mailing Address - Fax:321-254-0656
Practice Address - Street 1:7780 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8262
Practice Address - Country:US
Practice Address - Phone:321-254-1072
Practice Address - Fax:321-254-0656
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24840183500000X
NJ28RI03289600183500000X
FLPS0037223183500000X
SC35405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist