MEDICARE: DR. JERRY E BOTTS PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	044270	MO

General Provider Information

NPI Number	:	1023065521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY E BOTTS PHARM D

Provider Business Mailing Address
First Line	:	131 FOREST DR
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-9613
Country	:	US
Telephone Number	:	417-624-6922
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 S MAIN ST
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-1000
Country	:	US
Telephone Number	:	417-649-7021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/08/2007

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