Provider Demographics
NPI:1174957583
Name:BOTEZ, EMANUELA (PHARMD)
Entity type:Individual
Prefix:
First Name:EMANUELA
Middle Name:
Last Name:BOTEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 COLUMBIA HOUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7764
Mailing Address - Country:US
Mailing Address - Phone:360-619-1733
Mailing Address - Fax:
Practice Address - Street 1:2500 COLUMBIA HOUSE BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7764
Practice Address - Country:US
Practice Address - Phone:360-619-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60356098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist