Provider Demographics
NPI:1659679264
Name:BEECHER, BETHANY COLLUP (RPH)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:COLLUP
Last Name:BEECHER
Suffix:
Gender:F
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:PO BOX 680062
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-0002
Mailing Address - Country:US
Mailing Address - Phone:770-509-7581
Mailing Address - Fax:
Practice Address - Street 1:15 N DIVISION ST NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2327
Practice Address - Country:US
Practice Address - Phone:706-235-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022782183500000X
FLPS41077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist