MEDICARE: BETTY JEAN RICHARDSON R.PH.

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	1835P2201X	Ambulatory Care Pharmacist	35782	CA

General Provider Information

NPI Number	:	1992207591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY JEAN RICHARDSON R.PH.

Provider Business Mailing Address
First Line	:	10130 SORRENTO VALLEY RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1643
Country	:	US
Telephone Number	:	858-622-2850
Fax Number	:	858-622-2852

Provider Business Practice Location Address
First Line	:	10130 SORRENTO VALLEY RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1643
Country	:	US
Telephone Number	:	858-622-2850
Fax Number	:	858-622-2852

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

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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