Provider Demographics
NPI:1861670945
Name:BETTCHER, TELENE DARICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TELENE
Middle Name:DARICE
Last Name:BETTCHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:TELENE
Other - Middle Name:DARICE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:2700 W 9TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7247
Mailing Address - Country:US
Mailing Address - Phone:920-236-1430
Mailing Address - Fax:920-236-1435
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-236-1430
Practice Address - Fax:920-236-1435
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist