Healthcare Provider Details

I. General information

NPI: 1417883588
Provider Name (Legal Business Name): BETHANI THOMAS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E WEST CONNECTOR
AUSTELL GA
30106-1358
US

IV. Provider business mailing address

183 MORELAND AVE SE UNIT 201
ATLANTA GA
30316-1338
US

V. Phone/Fax

Practice location:
  • Phone: 954-397-1276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028678
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: