MEDICARE: IHAB BOTROS

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	28RI02515900	NJ

General Provider Information

NPI Number	:	1962101089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IHAB BOTROS

Provider Business Mailing Address
First Line	:	2980 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-3820
Country	:	US
Telephone Number	:	201-993-3617
Fax Number	:	201-963-8616

Provider Business Practice Location Address
First Line	:	2980 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-3820
Country	:	US
Telephone Number	:	201-993-3617
Fax Number	:	201-963-8616

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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Directions to “ IHAB BOTROS ” Practice Location

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