Provider Demographics
NPI:1053693341
Name:BETHEL, GREGORY E (RPH)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:E
Last Name:BETHEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CHEYENNE ST.
Mailing Address - Street 2:P.O. BOX 116
Mailing Address - City:SCHOENCHEN
Mailing Address - State:KS
Mailing Address - Zip Code:67667-0116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 VINE ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2201
Practice Address - Country:US
Practice Address - Phone:785-628-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist