Provider Demographics
NPI:1962575878
Name:BOTTORFF, TERRY M (RPH)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:M
Last Name:BOTTORFF
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 1:25595 LA MIRADA ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5317
Mailing Address - Country:US
Mailing Address - Phone:714-963-4552
Mailing Address - Fax:
Practice Address - Street 1:21421 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7354
Practice Address - Country:US
Practice Address - Phone:714-963-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist