Healthcare Provider Details

I. General information

NPI: 1992808943
Provider Name (Legal Business Name): MARIA ANGELA BOTTALICO PHARM.D., RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 ALBANY POST ROAD
MONTROSE NY
10548
US

IV. Provider business mailing address

36 ROSE DRIVE
MAHOPAC NY
10541
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax:
Mailing address:
  • Phone: 914-737-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number048514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: