Provider Demographics
NPI:1184138489
Name:BETHLEHEM PHARMACY RX INC
Entity type:Organization
Organization Name:BETHLEHEM PHARMACY RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYAPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-375-7899
Mailing Address - Street 1:817 E 4TH ST
Mailing Address - Street 2:FL1
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1931
Mailing Address - Country:US
Mailing Address - Phone:610-419-6522
Mailing Address - Fax:610-419-6544
Practice Address - Street 1:817 E 4TH ST
Practice Address - Street 2:FLR1
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1931
Practice Address - Country:US
Practice Address - Phone:610-419-6522
Practice Address - Fax:610-419-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2173964OtherPK
PA103441843 0001Medicaid
PA1034418430001Medicaid