Healthcare Provider Details

I. General information

NPI: 1740275890
Provider Name (Legal Business Name): CHRISTOPHER DUER BOTT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 MADDOX BLVD
CHINCOTEAGUE VA
23336-2617
US

IV. Provider business mailing address

4227 SUNRISE DRIVE CIR
CHINCOTEAGUE VA
23336-1715
US

V. Phone/Fax

Practice location:
  • Phone: 757-336-3115
  • Fax:
Mailing address:
  • Phone: 757-336-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202012091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: