Provider Demographics
NPI:1417174160
Name:PACE, BETTY BLANTON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:BLANTON
Last Name:PACE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 OAKENGATE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4051
Mailing Address - Country:US
Mailing Address - Phone:804-794-3551
Mailing Address - Fax:
Practice Address - Street 1:1220 SYCAMORE SQUARE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-794-3551
Practice Address - Fax:804-794-1056
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist