Healthcare Provider Details

I. General information

NPI: 1619234440
Provider Name (Legal Business Name): JOHN D BODTKER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 COVEY DR
PLACERVILLE CA
95667-6077
US

IV. Provider business mailing address

1667 COVEY DR
PLACERVILLE CA
95667-6077
US

V. Phone/Fax

Practice location:
  • Phone: 530-663-3534
  • Fax:
Mailing address:
  • Phone: 530-663-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number62197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: