Healthcare Provider Details

I. General information

NPI: 1366555948
Provider Name (Legal Business Name): BRIAN BOTTEMILLER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39050 HIGHWAY 299
WILLOW CREEK CA
95573-0067
US

IV. Provider business mailing address

PO BOX 67
WILLOW CREEK CA
95573-0067
US

V. Phone/Fax

Practice location:
  • Phone: 530-629-3144
  • Fax: 530-629-4303
Mailing address:
  • Phone: 530-629-3144
  • Fax: 530-629-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH37624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number37624
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: