Healthcare Provider Details

I. General information

NPI: 1417954157
Provider Name (Legal Business Name): BETH ANNETTE BAGWELL PHARM.D., CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N HOBART ST
PAMPA TX
79065-4124
US

IV. Provider business mailing address

2301 BEECH LN
PAMPA TX
79065-3024
US

V. Phone/Fax

Practice location:
  • Phone: 806-665-7642
  • Fax: 806-665-7226
Mailing address:
  • Phone: 806-688-0148
  • Fax: 806-665-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20987
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: