Provider Demographics
NPI:1124399266
Name:BOTROS, AYMEN
Entity Type:Individual
Prefix:
First Name:AYMEN
Middle Name:
Last Name:BOTROS
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 1:8514 FAWN CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:646-644-9467
Mailing Address - Fax:
Practice Address - Street 1:8514 FAWN CREEK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2323
Practice Address - Country:US
Practice Address - Phone:646-644-9467
Practice Address - Fax:646-644-9467
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist