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NPI Code Detail

MEDICARE: DR. SEAN RUSSEL OTT PHARMD.

MEDICARE: DR. SEAN RUSSEL OTT PHARMD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist19820NC

General Provider Information

NPI Number : 1699182600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SEAN RUSSEL OTT PHARMD.
Provider Business Mailing Address
First Line : 330 MOCKINGBIRD DR
Second Line :
City : HENDERSONVILLE
State : NC
Zip : 28792-6554
Country : US
Telephone Number : 828-287-3026
Fax Number : 828-287-3026
Provider Business Practice Location Address
First Line : 197 PLAZA DR
Second Line :
City : FOREST CITY
State : NC
Zip : 28043-3712
Country : US
Telephone Number : 828-287-3026
Fax Number : 828-287-3026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2014
Last Update Date : 07/22/2014

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Directions to “ DR. SEAN RUSSEL OTT PHARMD.” Practice Location

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