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General NPI Number Information
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NPI Number | 1932700622
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Entity Type | Individual
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Provider Name | BETHANY MARIE HOLDEN
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Gender | Female
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Dates
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Enumeration Date | 11/08/2020
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Last Update Date | 11/08/2020
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Provider Practice Location Address
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Address Line | 1201 29TH ST SE
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City | WATERTOWN
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State | SD
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Zip | 57201-9179
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Country | US
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Telephone | 605-886-8419
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Fax |
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Provider Business Mailing Address
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Address Line | 19211 467TH AVE
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City | ESTELLINE
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State | SD
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Zip | 57234-5648
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Country | US
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Telephone | 605-691-1899
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5475
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License Number State | SD
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