Healthcare Provider Details

I. General information

NPI: 1427734706
Provider Name (Legal Business Name): RIMOUN BOTROS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 GASKINS RD
RICHMOND VA
23238-4919
US

IV. Provider business mailing address

161 BUSH RIVER DR
FARMVILLE VA
23901-3183
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202220691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: