Healthcare Provider Details

I. General information

NPI: 1578668935
Provider Name (Legal Business Name): SHEILA R BOTTS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR CDD 119
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

158 TREETOP CT
GEORGETOWN KY
40324-9110
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-323-0069
Mailing address:
  • Phone: 502-867-4813
  • Fax: 859-323-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number10522
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: