Provider Demographics
NPI:1902153638
Name:SCHULTZ, BETHANY LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYNN
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1407
Mailing Address - Country:US
Mailing Address - Phone:330-847-0016
Mailing Address - Fax:
Practice Address - Street 1:5001 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1407
Practice Address - Country:US
Practice Address - Phone:330-847-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist