Provider Demographics
NPI:1164034971
Name:PAZHAYATTIL, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:PAZHAYATTIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 BELLA TERRA CENTER WAY APT 11105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1661
Mailing Address - Country:US
Mailing Address - Phone:954-471-8603
Mailing Address - Fax:
Practice Address - Street 1:8960 BARKER CYPRESS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1644
Practice Address - Country:US
Practice Address - Phone:281-656-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist