Individual
LOURENS RASMUS BOTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1613 N MAIN STREET, SAN LUIS, AZ 85349
(928) 722-7288
Mailing address
3882 S TILLMAN WAY, YUMA, AZ 85365-6715
(928) 581-0703
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S015983
AZ
Other
Enumeration date
04/24/2017
Last updated
04/27/2017
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