Healthcare Provider Details

I. General information

NPI: 1962812610
Provider Name (Legal Business Name): BETSY ABRAHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 05/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 OCEANSIDE BLVD
OCEANSIDE CA
92056-3471
US

IV. Provider business mailing address

331 W RINCON ST UNIT 307
CORONA CA
92880-5717
US

V. Phone/Fax

Practice location:
  • Phone: 281-704-9380
  • Fax:
Mailing address:
  • Phone: 281-704-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: