Provider Demographics
NPI:1992207591
Name:RICHARDSON, BETTY JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:RICHARDSON
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 1:10130 SORRENTO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1643
Mailing Address - Country:US
Mailing Address - Phone:858-622-2850
Mailing Address - Fax:858-622-2852
Practice Address - Street 1:10130 SORRENTO VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1643
Practice Address - Country:US
Practice Address - Phone:858-622-2850
Practice Address - Fax:858-622-2852
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA357821835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care