Provider Demographics
NPI:1215207881
Name:BOTES, JOHANNES JACOBUS (BSCPHARM)
Entity Type:Individual
Prefix:MR
First Name:JOHANNES
Middle Name:JACOBUS
Last Name:BOTES
Suffix:
Gender:M
Credentials:BSCPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3207
Mailing Address - Country:US
Mailing Address - Phone:407-628-1899
Mailing Address - Fax:407-628-8842
Practice Address - Street 1:1920 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3207
Practice Address - Country:US
Practice Address - Phone:407-628-1899
Practice Address - Fax:407-628-8842
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist