Healthcare Provider Details

I. General information

NPI: 1437404902
Provider Name (Legal Business Name): BETHANY STRATTON CROSS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 VETERANS MEMORIAL DR
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

2416 S 13TH ST APT 923
TEMPLE TX
76504-7821
US

V. Phone/Fax

Practice location:
  • Phone: 765-860-4291
  • Fax:
Mailing address:
  • Phone: 765-860-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302040650
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040650
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: