Provider Demographics
NPI:1306128376
Name:LINES, BETHANY LEAH (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:LEAH
Last Name:LINES
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3845 HAVENSPORT RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9426
Mailing Address - Country:US
Mailing Address - Phone:740-503-1557
Mailing Address - Fax:740-654-2865
Practice Address - Street 1:859 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3940
Practice Address - Country:US
Practice Address - Phone:740-654-2592
Practice Address - Fax:740-654-2865
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227889-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist