Provider Demographics
NPI:1164714770
Name:BOTROS, ALEXANDER MICHAEL (RPH, JD)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:BOTROS
Suffix:
Gender:M
Credentials:RPH, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 MAIN ST
Mailing Address - Street 2:RITE AID 922
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-3107
Mailing Address - Country:US
Mailing Address - Phone:860-274-9191
Mailing Address - Fax:860-274-4370
Practice Address - Street 1:1271 MAIN ST
Practice Address - Street 2:RITE AID 922
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-3107
Practice Address - Country:US
Practice Address - Phone:860-274-9191
Practice Address - Fax:860-274-4370
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist