Basic Information
| Provider Information | |||||||||
| NPI: | 1992808943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOTTALICO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ANGELA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D., RPH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 ROSE DRIVE | ||||||||
| Address2: | |||||||||
| City: | MAHOPAC | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2090 ALBANY POST ROAD | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 048514 | NY | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.