Provider Demographics
NPI:1497039382
Name:BOTTOLFSEN, SCOT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:
Last Name:BOTTOLFSEN
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 1:4713 FLINTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4230
Mailing Address - Country:US
Mailing Address - Phone:719-219-3747
Mailing Address - Fax:719-219-4340
Practice Address - Street 1:4713 FLINTRIDGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4230
Practice Address - Country:US
Practice Address - Phone:719-219-3747
Practice Address - Fax:719-219-4340
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist