Provider Demographics
NPI:1316054570
Name:BOTHMANN, NORMAN H (RPH)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:H
Last Name:BOTHMANN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 459
Mailing Address - Street 2:BOX 26201
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09139
Mailing Address - Country:US
Mailing Address - Phone:01149951-300-7683
Mailing Address - Fax:
Practice Address - Street 1:USAHC, BAMBERG
Practice Address - Street 2:CMR 459, BOX 26201
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139
Practice Address - Country:US
Practice Address - Phone:01149951-300-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 25702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist