MEDICARE: ADILENE MARIA BETANCOURT PHARMACY TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator
2	183700000X	Pharmacy Technician	T023541	AZ

General Provider Information

NPI Number	:	1316535420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADILENE MARIA BETANCOURT PHARMACY TECHNICIAN

Provider Business Mailing Address
First Line	:	2020 N FORBES BLVD STE 252
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1415
Country	:	US
Telephone Number	:	844-326-3043
Fax Number	:	520-885-5074

Provider Business Practice Location Address
First Line	:	2020 N FORBES BLVD STE 252
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-1415
Country	:	US
Telephone Number	:	844-326-3043
Fax Number	:	520-885-5074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	01/05/2021

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