Provider Demographics
NPI:1578958732
Name:RIZKE, BOTROS
Entity Type:Individual
Prefix:
First Name:BOTROS
Middle Name:
Last Name:RIZKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2862 HYLAN BLVD
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4651
Mailing Address - Country:US
Mailing Address - Phone:347-522-4146
Mailing Address - Fax:
Practice Address - Street 1:525 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1080
Practice Address - Country:US
Practice Address - Phone:610-373-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449216183500000X
TX55150183500000X
WVRP0008367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist