Provider Demographics
NPI:1841037553
Name:BETTINGER, BRETT
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:BETTINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 SIENA HEIGHTS DR STE 111
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4168
Mailing Address - Country:US
Mailing Address - Phone:702-476-9088
Mailing Address - Fax:702-442-8123
Practice Address - Street 1:2865 SIENA HEIGHTS DR STE 111
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4168
Practice Address - Country:US
Practice Address - Phone:702-476-9088
Practice Address - Fax:702-442-8123
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist