Provider Demographics
NPI:1023171295
Name:BETHEL DRUG COMPANY
Entity type:Organization
Organization Name:BETHEL DRUG COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:229-244-0640
Mailing Address - Street 1:2921 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1725
Mailing Address - Country:US
Mailing Address - Phone:222-244-0640
Mailing Address - Fax:229-245-1393
Practice Address - Street 1:2921 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1725
Practice Address - Country:US
Practice Address - Phone:222-244-0640
Practice Address - Fax:229-245-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE010379OtherGA BOARD OF PHARMACY
GA000811566AMedicaid
GA1115206OtherNCPDP #
GA1115206OtherNCPDP #