Provider Demographics
NPI:1487191490
Name:BOTROS, AFRAIM (RPH)
Entity Type:Individual
Prefix:
First Name:AFRAIM
Middle Name:
Last Name:BOTROS
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 1:33 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1043
Mailing Address - Country:US
Mailing Address - Phone:973-482-1556
Mailing Address - Fax:
Practice Address - Street 1:33 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1043
Practice Address - Country:US
Practice Address - Phone:973-482-1556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03711500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist