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NPI Code Detail

MEDICARE: BETH ILLSLEY RPH

MEDICARE:   BETH  ILLSLEY  RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist39751TX

General Provider Information

NPI Number : 1326710435
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH ILLSLEY RPH
Provider Business Mailing Address
First Line : PO BOX 950
Second Line :
City : JACKSONVILLE
State : TX
Zip : 75766-0950
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 16541 FM 344 W
Second Line :
City : BULLARD
State : TX
Zip : 75757-9551
Country : US
Telephone Number : 903-825-7011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2021
Last Update Date : 09/28/2021

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Directions to “ BETH ILLSLEY RPH” Practice Location

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