Provider Demographics
NPI:1174821243
Name:BOTROS, ADEL ABDELMASSIH (RPH)
Entity Type:Individual
Prefix:MR
First Name:ADEL
Middle Name:ABDELMASSIH
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 1:112 ORCHARD HILL DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8618
Mailing Address - Country:US
Mailing Address - Phone:717-832-3131
Mailing Address - Fax:
Practice Address - Street 1:1130 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5150
Practice Address - Country:US
Practice Address - Phone:717-273-2281
Practice Address - Fax:717-272-4160
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042738L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist