MEDICARE: PAUL BOTROS MEKHAEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S017646	AZ

General Provider Information

NPI Number	:	1891011607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BOTROS MEKHAEL

Provider Business Mailing Address
First Line	:	7450 W GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3000
Country	:	US
Telephone Number	:	623-915-2639
Fax Number	:	623-915-2642

Provider Business Practice Location Address
First Line	:	7450 W GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3000
Country	:	US
Telephone Number	:	623-915-2639
Fax Number	:	623-915-2642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	06/20/2015

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Directions to “ PAUL BOTROS MEKHAEL ” Practice Location

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