Provider Demographics
NPI:1629869789
Name:BOTROS, KEROLS MELAD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEROLS
Middle Name:MELAD
Last Name:BOTROS
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 1:1932 ALMAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4404
Mailing Address - Country:US
Mailing Address - Phone:615-637-0899
Mailing Address - Fax:
Practice Address - Street 1:1932 ALMAVILLE RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4404
Practice Address - Country:US
Practice Address - Phone:615-481-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN48447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy