Organization
BETHANY HOME DISCOUNT PHARMACY LLC
Active
Other names
BETHANY HOME DISCOUNT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSHMITHA GODISHALA (MEMBER)
(602) 585-2901
Entity
Organization
Contact information
Practice address
6601 W BETHANY HOME RD STE A10, GLENDALE, AZ 85301-4946
(623) 440-7717
(623) 440-7781
Mailing address
6601 W BETHANY HOME RD STE A10, GLENDALE, AZ 85301-4946
(623) 440-7717
(623) 440-7781
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y008159
ARIZONA BOARD OF PHARMACY
AZ
Enumeration date
07/29/2019
Last updated
08/15/2022
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