Provider Demographics
NPI:1790064434
Name:BOTTI, MARK CHRISTIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTIAN
Last Name:BOTTI
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 1:1201 ROUTE 300
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5005
Mailing Address - Country:US
Mailing Address - Phone:845-567-6093
Mailing Address - Fax:
Practice Address - Street 1:1201 ROUTE 300
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5005
Practice Address - Country:US
Practice Address - Phone:845-567-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20-055935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist