Provider Demographics
NPI:1407357676
Name:BOTTOMS, JAMES (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BOTTOMS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 LAKEVIEW ISLE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5852
Mailing Address - Country:US
Mailing Address - Phone:404-392-6565
Mailing Address - Fax:
Practice Address - Street 1:3920 LAKEVIEW ISLE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5852
Practice Address - Country:US
Practice Address - Phone:404-392-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU7826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183500000XPharmacy Service ProvidersPharmacist