Provider Demographics
NPI:1912349929
Name:ROSE, BETHANY ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ANNE
Last Name:ROSE
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 1:801 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-2261
Mailing Address - Country:US
Mailing Address - Phone:765-832-1224
Mailing Address - Fax:765-832-1298
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-2261
Practice Address - Country:US
Practice Address - Phone:765-832-1224
Practice Address - Fax:765-832-1298
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024026A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist