MEDICARE: DR. BETTY JEAN DONG PHARMD

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	183500000X	Pharmacist	RPH27874	CA

General Provider Information

NPI Number	:	1356341515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTY JEAN DONG PHARMD

Provider Business Mailing Address
First Line	:	UNIV OF CALIFORNIA SCHOOL OF PHARMACY
Second Line	:	521 PARNASSUS AVE RM C 152
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0622
Country	:	US
Telephone Number	:	415-476-1972
Fax Number	:	415-476-6632

Provider Business Practice Location Address
First Line	:	UNIV OF CALIFORNIA SCHOOL OF PHARMACY
Second Line	:	521 PARNASSUS AVE RM C 152
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0622
Country	:	US
Telephone Number	:	415-476-1972
Fax Number	:	415-476-6632

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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