Healthcare Provider Details

I. General information

NPI: 1851071450
Provider Name (Legal Business Name): DANIEL RYAN OTIS PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 99TH AVE
TOLLESON AZ
85353-9700
US

IV. Provider business mailing address

4368 W BEHREND DR
GLENDALE AZ
85308-7377
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-9663
  • Fax:
Mailing address:
  • Phone: 208-403-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026502
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: