Provider Demographics
NPI:1396050423
Name:BOTELLO, ELAINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:BOTELLO
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 1:2660 FOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7606
Mailing Address - Country:US
Mailing Address - Phone:713-278-8474
Mailing Address - Fax:713-278-8614
Practice Address - Street 1:2660 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7606
Practice Address - Country:US
Practice Address - Phone:713-278-8474
Practice Address - Fax:713-278-8614
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist