Healthcare Provider Details

I. General information

NPI: 1861201576
Provider Name (Legal Business Name): YOUSEF KOTB RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PEMBERTON BROWNS MILL RD
BROWNS MILLS NJ
08015-3112
US

IV. Provider business mailing address

508 HIGH ST
MOUNT HOLLY NJ
08060-1052
US

V. Phone/Fax

Practice location:
  • Phone: 609-386-9411
  • Fax:
Mailing address:
  • Phone: 609-386-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04413100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: