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General NPI Number Information
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NPI Number | 1649556606
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Entity Type | Individual
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Provider Name | PHOEBE BOTROS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/22/2011
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Last Update Date | 10/22/2011
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Provider Practice Location Address
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Address Line | 3522 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53208-3846
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Country | US
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Telephone | 414-324-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 N COMMERCE ST 512
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City | MILWAUKEE
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State | WI
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Zip | 53212-3475
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 15024-040
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License Number State | WI
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