Provider Demographics
NPI:1487708939
Name:BETTENCOURT, NORMAN BRUCE (RPH)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:BRUCE
Last Name:BETTENCOURT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5018 THURBER LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1153
Mailing Address - Country:US
Mailing Address - Phone:831-475-0721
Mailing Address - Fax:831-462-2787
Practice Address - Street 1:550 WATER ST STE H
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4133
Practice Address - Country:US
Practice Address - Phone:831-423-4363
Practice Address - Fax:831-423-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist