Provider Demographics
NPI:1063016350
Name:BOTROS, EBRAM (RPH)
Entity Type:Individual
Prefix:
First Name:EBRAM
Middle Name:
Last Name:BOTROS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-2500
Mailing Address - Country:US
Mailing Address - Phone:614-556-2005
Mailing Address - Fax:
Practice Address - Street 1:4548 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-3039
Practice Address - Country:US
Practice Address - Phone:614-235-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03333872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist