Healthcare Provider Details

I. General information

NPI: 1831586890
Provider Name (Legal Business Name): MICHELLE OTWELL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SUMMERCHASE DR
HOOVER AL
35244-2843
US

IV. Provider business mailing address

1810 SUMMERCHASE DR
HOOVER AL
35244-2843
US

V. Phone/Fax

Practice location:
  • Phone: 205-253-4185
  • Fax:
Mailing address:
  • Phone: 205-253-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17722
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: