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General NPI Number Information
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NPI Number | 1689808537
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Entity Type | Individual
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Provider Name | MR. GEORGE FREDERICK BOTHMA
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Gender | Male
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 100 COVERED VLG
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City | BELDING
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State | MI
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Zip | 48809-1683
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Country | US
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Telephone | 616-794-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 11073 STREAMSIDE DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-8604
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Country | US
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Telephone | 616-866-2450
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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 | 5302036700
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License Number State | MI
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