Organization
BETHEL BUSINESS LLC
Active
Other names
Ivywild Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE BETHEL RPH (OWNER)
(719) 547-7557
Entity
Organization
Contact information
Practice address
311 S NEVADA AVE, COLORADO SPRINGS, CO 80903-2107
(719) 634-5541
(719) 634-0692
Mailing address
311 S NEVADA AVE, COLORADO SPRINGS, CO 80903-2107
(719) 634-5541
(719) 634-0692
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO0240000019
CO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03380508
—
CO
01
—
2140939
PK
—
05
—
64108066
—
CO
Enumeration date
07/22/2006
Last updated
02/07/2024
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