Provider Demographics
NPI:1477701480
Name:BOTTARO, SAMUEL DUDLEY II (RPH, DPH)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DUDLEY
Last Name:BOTTARO
Suffix:II
Gender:M
Credentials:RPH, DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 S 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4407
Mailing Address - Country:US
Mailing Address - Phone:402-651-2413
Mailing Address - Fax:
Practice Address - Street 1:9701 S 26TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4407
Practice Address - Country:US
Practice Address - Phone:402-651-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8331183500000X
OK12328183500000X
IA18954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist