Provider Demographics
NPI:1790908762
Name:BOTROS, SAMIH NABIL (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMIH
Middle Name:NABIL
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 1:26732 CROWN VALLEY PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8531
Mailing Address - Country:US
Mailing Address - Phone:949-364-1200
Mailing Address - Fax:949-364-7240
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8531
Practice Address - Country:US
Practice Address - Phone:949-364-1200
Practice Address - Fax:949-364-7240
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist