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General NPI Number Information
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NPI Number | 1902157183
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Entity Type | Individual
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Provider Name | BETHANY WIRTZ PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 301 PARK DR
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City | OWATONNA
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State | MN
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Zip | 55060-5639
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Country | US
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Telephone | 507-451-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 315 CENTER ST
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City | MANKATO
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State | MN
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Zip | 56001-3939
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 121079
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License Number State | MN
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