| Doctor Name: | MRS. BETH ANN LONGBRAKE |
| NPI Number: | 1053721852 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 26019104A |
| Business Practice Address: | 5020 Grape Rd Mishawaka, IN - 465458708 |
| Business Phone Number: | 5742733533 |
| Business Fax Number: | 5742733565 |
| Mailing Address: | 5020 Grape Rd, MISHAWAKA |
| State: | IN |
| Postal Code: | 465458708 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2014 |
| NPI Last Update Date: | 05/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P1200X |
| License Number: | 26019104A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacotherapy |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in optimizing pharmacotherapeutic care of patients, by developing, implementing, monitoring, and modifying complex treatment plans, providing advanced level education and consultation, and collaborating with other health professionals in the management of therapy. |