Healthcare Provider Details

I. General information

NPI: 1568870269
Provider Name (Legal Business Name): CARSON BECHTOLD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

930 N AUSTIN BLVD APT 103
OAK PARK IL
60302-1781
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2488
  • Fax:
Mailing address:
  • Phone: 717-875-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 51837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: