Provider Demographics
NPI:1548471451
Name:HARRIS, BETTY JEAN (PHARMD, FASCP)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:JEAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARMD, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7920
Mailing Address - Country:US
Mailing Address - Phone:954-296-0453
Mailing Address - Fax:954-426-5428
Practice Address - Street 1:4920 NE 29TH AVE
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7920
Practice Address - Country:US
Practice Address - Phone:954-296-0453
Practice Address - Fax:954-426-5428
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL159791835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric