Provider Demographics
NPI:1215052238
Name:BETHEL, THOMAS DEAN (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DEAN
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 1:4092 SUCIA DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9506
Mailing Address - Country:US
Mailing Address - Phone:360-392-8673
Mailing Address - Fax:
Practice Address - Street 1:3227 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1317
Practice Address - Country:US
Practice Address - Phone:360-647-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPL00009600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPL00009600OtherPHARMACIST LIC. NUMBER