Clark Anthony Botha, BPHARM, RPH
Individual provider Active NPI Pharmacist · Beaumont, CA
NPI 1639385404 · NPPES record last updated Dec 27, 2019
Key facts
- NPI
- 1639385404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 58078 (CA)
- Practice address
- 81 Highland Springs Ave Ste 90
Beaumont, CA 92223-3170 - Phone
- (951) 849-3378
- NPI assigned
- May 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58078 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrifty Payless Inc | Past | Accepting new patients | |
| Seventh Day Adventists Loma Linda University Medical Center, Inc. | Past |
Accepting new patients | |
| Thrifty Payless Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 58078 | CA | Yes |
Addresses
Primary practice location
81 Highland Springs Ave Ste 90
Beaumont, CA 92223-3170
Mailing address
25590 Prospect Ave
Apt 26D
Loma Linda, CA 92354-3141
Phone (909) 801-4312
Other providers in Beaumont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.