Provider Demographics
NPI:1912083981
Name:BETHEL PHARMACY INC
Entity Type:Organization
Organization Name:BETHEL PHARMACY INC
Other - Org Name:BETHEL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNGHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-741-0075
Mailing Address - Street 1:17414HWY 99
Mailing Address - Street 2:STE 100
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037
Mailing Address - Country:US
Mailing Address - Phone:425-741-0075
Mailing Address - Fax:425-741-0083
Practice Address - Street 1:17414HWY 99
Practice Address - Street 2:STE 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037
Practice Address - Country:US
Practice Address - Phone:425-741-0075
Practice Address - Fax:425-741-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHARCF604025483336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6027189Medicaid
2108100OtherPK
5296160001Medicare NSC