Healthcare Provider Details

I. General information

NPI: 1417628348
Provider Name (Legal Business Name): BETCY TIJU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 AUBURN RD
DACULA GA
30019-5434
US

IV. Provider business mailing address

831 AUBURN RD
DACULA GA
30019-5434
US

V. Phone/Fax

Practice location:
  • Phone: 770-682-2627
  • Fax:
Mailing address:
  • Phone: 770-682-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH033265
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: