Healthcare Provider Details

I. General information

NPI: 1891011607
Provider Name (Legal Business Name): PAUL BOTROS MEKHAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 06/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 W GLENDALE AVE
GLENDALE AZ
85303-3000
US

IV. Provider business mailing address

7450 W GLENDALE AVE
GLENDALE AZ
85303-3000
US

V. Phone/Fax

Practice location:
  • Phone: 623-915-2639
  • Fax: 623-915-2642
Mailing address:
  • Phone: 623-915-2639
  • Fax: 623-915-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS017646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: