Provider Demographics
NPI:1861297459
Name:BETANCOURT, ALEXIS NOELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NOELLE
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 ROJAS DR STE I
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7721
Mailing Address - Country:US
Mailing Address - Phone:915-910-7070
Mailing Address - Fax:915-910-4607
Practice Address - Street 1:12025 ROJAS DR STE I
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7721
Practice Address - Country:US
Practice Address - Phone:915-910-7070
Practice Address - Fax:915-910-4607
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist