Healthcare Provider Details

I. General information

NPI: 1861670945
Provider Name (Legal Business Name): TELENE DARICE BETTCHER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TELENE DARICE SMITH PHARMACIST

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 9TH AVE SUITE 108
OSHKOSH WI
54904-7247
US

IV. Provider business mailing address

2700 W 9TH AVE SUITE 108
OSHKOSH WI
54904-7247
US

V. Phone/Fax

Practice location:
  • Phone: 920-236-1430
  • Fax: 920-236-1435
Mailing address:
  • Phone: 920-236-1430
  • Fax: 920-236-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12739
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: