Provider Demographics
NPI:1740814987
Name:BETTS, DAVID HAYNES III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HAYNES
Last Name:BETTS
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2104 MEMORIAL DR APT 105
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54303-1291
Mailing Address - Country:US
Mailing Address - Phone:847-848-1911
Mailing Address - Fax:
Practice Address - Street 1:2470 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4711
Practice Address - Country:US
Practice Address - Phone:920-494-0536
Practice Address - Fax:920-494-1131
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19547-403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy