Provider Demographics
NPI:1396027447
Name:BOTROS, MARIAN M (RPH)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:M
Last Name:BOTROS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S DOHENY DR APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3778
Mailing Address - Country:US
Mailing Address - Phone:323-244-4975
Mailing Address - Fax:
Practice Address - Street 1:323 S DOHENY DR APT 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3778
Practice Address - Country:US
Practice Address - Phone:323-244-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist