1104412089 NPI number — DR. BETHANY LEA HOOPES PHARMD.

Table of content: DR. BETHANY LEA HOOPES PHARMD. (NPI 1104412089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104412089 NPI number — DR. BETHANY LEA HOOPES PHARMD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOPES
Provider First Name:
BETHANY
Provider Middle Name:
LEA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104412089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19074 COUNTY ROAD G40
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LETTS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52754-9403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-929-4266
Provider Business Mailing Address Fax Number:
319-228-8101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN HORNE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52346-9718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-228-8100
Provider Business Practice Location Address Fax Number:
319-228-8101
Provider Enumeration Date:
12/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  19744 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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