Provider Demographics
NPI:1619234440
Name:BODTKER, JOHN D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:BODTKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 PLATEAU CIR
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8160
Mailing Address - Country:US
Mailing Address - Phone:530-672-2692
Mailing Address - Fax:
Practice Address - Street 1:4023 PLATEAU CIR
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8160
Practice Address - Country:US
Practice Address - Phone:530-672-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA621971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist