Provider Demographics
NPI:1346347184
Name:BOTROSONS PHARMACEUTICAL INC
Entity Type:Organization
Organization Name:BOTROSONS PHARMACEUTICAL INC
Other - Org Name:TOWER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:SAMIH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTROS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:949-364-1200
Mailing Address - Street 1:26732 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6306
Mailing Address - Country:US
Mailing Address - Phone:949-364-1200
Mailing Address - Fax:949-364-7240
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-1200
Practice Address - Fax:949-364-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY466883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA466880Medicaid
0593649OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5251590001Medicare NSC