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General NPI Number Information
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NPI Number | 1962575878
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Entity Type | Individual
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Provider Name | TERRY M BOTTORFF RPH
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 07/08/2007
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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 |
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Provider Business Mailing Address
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Address Line | 25595 LA MIRADA ST
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5317
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Country | US
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Telephone | 714-963-4552
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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 | 27318
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License Number State | CA
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