Provider Demographics
NPI:1457644411
Name:BOTTESCH, HANS WERNER (RPH)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:WERNER
Last Name:BOTTESCH
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 1:2106 SUNNY LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8787
Mailing Address - Country:US
Mailing Address - Phone:570-594-0705
Mailing Address - Fax:
Practice Address - Street 1:126 WHITE BIRCH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9147
Practice Address - Country:US
Practice Address - Phone:570-594-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030438L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist