MEDICARE: BETHEL BUSINESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821604646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL BUSINESS LLC

Provider Business Mailing Address
First Line	:	1640 S NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-2222
Country	:	US
Telephone Number	:	719-634-5541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 S NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-2222
Country	:	US
Telephone Number	:	719-634-5541
Fax Number	:	719-634-0692

Authorized Official
Title or Position	:	PHARMACIST/CO OWNER
Name	:	MRS. SHANNON BELLE BETHEL
Credential	:	RPH
Telephone Number	:	719-634-5541

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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Directions to “BETHEL BUSINESS LLC ” Practice Location

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