Provider Demographics
NPI:1932621679
Name:BOTZENHART, DANIEL JACOB (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JACOB
Last Name:BOTZENHART
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 16TH AVE SE STE 202
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9694
Mailing Address - Country:US
Mailing Address - Phone:828-465-6822
Mailing Address - Fax:
Practice Address - Street 1:102 HARPER AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5057
Practice Address - Country:US
Practice Address - Phone:828-754-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist