NPIMap

Botrosons Pharmaceutical Inc

Organization Active NPI Community/Retail Pharmacy · Colton, CA

NPI 1396834073 · NPPES record last updated Feb 16, 2017

Key facts

NPI
1396834073
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
PHY47035 (CA)
Legal business name
BOTROSONS PHARMACEUTICAL INC
Practice address
142 W H St
Colton, CA 92324-2923
Phone
(909) 825-1950
Fax
(909) 825-9330
NPI assigned
Oct 12, 2006
Organization subpart
No

Authorized official

Name
Ed Botros, BACHELOR DEGREE
Title
Pic
Phone
(909) 825-1950

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Larson'S Pharmacy
142 West H St, Colton, CA 92324-2923 · (909) 825-1950		 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf Does not accept assignment
Participating since Jun 9, 2004

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930071230 CA DME Supplier - Pharmacy
DME Supplier - Medical Supply Company With Registered Pharmacist		 7719196013 Practice locations: Colton, CA

National Provider Directory

Tax ID family
Botrosons Pharmaceutical Inc (2 organizations share this tax ID)

Locations

142 W H St
Colton, CA 92324
Phone (909) 825-1950

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY47035 CA Yes

Addresses

Primary practice location

142 W H St
Colton, CA 92324-2923

Mailing address

142 W H St
Colton, CA 92324-2923
Phone (909) 825-1950

Other identifiers

IdentifierTypeStateIssuer
PHA174020MedicaidCA
PHA470350MedicaidCA
1996200OtherPK

Other names

  • LARSON'S PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 16, 2017.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1396834073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 W H ST",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923242923",
            "telephone_number": "909-825-1950",
            "fax_number": "909-825-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 W H ST",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923242923",
            "telephone_number": "909-825-1950",
            "fax_number": "909-825-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTROSONS PHARMACEUTICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "BOTROS",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "909-825-1950",
        "authorized_official_credential": "BACHELOR DEGREE"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY47035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA174020",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA470350",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1996200",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LARSON'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colton, CA

All providers in Colton, CA · Community/Retail Pharmacy in California

Sources for this page

Verify at the official NPI Registry.