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General NPI Number Information
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NPI Number | 1063457638
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Entity Type | Organization
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Legal Business Name | BROOKHURST DRUG INC TERRY BOTTORFF PRES
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 21421 BROOKHURST ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-7354
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Country | US
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Telephone | 714-963-4552
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Fax | 714-963-1705
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Provider Business Mailing Address
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Address Line | 21421 BROOKHURST ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-7354
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Country | US
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Telephone | 714-963-4552
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Fax | 714-963-1705
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TERRY M BOTTORFF
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Credential | RPH
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Telephone | 714-963-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY34032
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License Number State | CA
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