Provider Demographics
NPI:1699368654
Name:BOTCHEK, SCOTT KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KEVIN
Last Name:BOTCHEK
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 1:405 SE EVERETT MALL WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3243
Mailing Address - Country:US
Mailing Address - Phone:425-353-7967
Mailing Address - Fax:
Practice Address - Street 1:405 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3243
Practice Address - Country:US
Practice Address - Phone:425-353-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist