Provider Demographics
NPI:1649875535
Name:BOTA, SAMIR
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:BOTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 CONGRESS AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1547
Mailing Address - Country:US
Mailing Address - Phone:619-855-3399
Mailing Address - Fax:
Practice Address - Street 1:1045 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6545
Practice Address - Country:US
Practice Address - Phone:305-421-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist