Healthcare Provider Details

I. General information

NPI: 1376946129
Provider Name (Legal Business Name): BETHANY ANN HOFMANN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WESTLOOP PL
MANHATTAN KS
66502-2837
US

IV. Provider business mailing address

1101 WESTLOOP PL
MANHATTAN KS
66502-2837
US

V. Phone/Fax

Practice location:
  • Phone: 785-539-9454
  • Fax:
Mailing address:
  • Phone: 785-539-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16181
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: