Bethany Pharmacy , Inc.

Primary specialty

Pharmacotherapy PharmacistTaxonomy code 1835P1200X

License

16 Issued in ND

Legal business name

BETHANY PHARMACY , INC.

Practice address

201 University Dr S
Fargo, ND 58103-1775

Phone

(701) 239-3543

Fax

(701) 239-3547

NPI assigned

Jan 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kay M Larson, RPH

Title

Owner

Phone

(701) 239-3543

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1346392149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031775",
            "telephone_number": "701-239-3543",
            "fax_number": "701-239-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031775",
            "telephone_number": "701-239-3543",
            "fax_number": "701-239-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY PHARMACY , INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KAY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-239-3543",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "ND",
            "license": "16",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21120",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.