Organization
BETHEL BUSINESS LLC
Active
Parent organization
BETHEL BUSINESS LLC
Other names
Ivywild Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
BETHEL BUSINESS LLC
Authorized official
MRS. SHANNON BELLE BETHEL RPH (PHARMACIST/CO OWNER)
(719) 634-5541
Entity
Organization
Contact information
Practice address
1640 S NEVADA AVE, COLORADO SPRINGS, CO 80905-2222
(719) 634-5541
(719) 634-0692
Mailing address
1640 S NEVADA AVE, COLORADO SPRINGS, CO 80905-2222
(719) 634-5541
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64108066
—
CO
Enumeration date
09/17/2020
Last updated
09/17/2020
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