Basic Information
| Provider Information | |||||||||
| NPI: | 1437793221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOTOLFSON | ||||||||
| FirstName: | NEAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3220 SEAWAY DR | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346523028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278461428 | ||||||||
| FaxNumber: | 7272645223 | ||||||||
| Practice Location | |||||||||
| Address1: | 8745 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346544947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272645224 | ||||||||
| FaxNumber: | 7272645223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2019 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS23255 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.