Healthcare Provider Details

I. General information

NPI: 1720295322
Provider Name (Legal Business Name): VEENA BETTEGOWDA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD COURT RD
RANDALLSTOWN MD
21133-5103
US

IV. Provider business mailing address

6 DIPPING POND CT
LUTHERVILLE MD
21093-3518
US

V. Phone/Fax

Practice location:
  • Phone: 410-701-4547
  • Fax:
Mailing address:
  • Phone: 434-257-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number17627
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: