Healthcare Provider Details

I. General information

NPI: 1730597667
Provider Name (Legal Business Name): NATOURI OTTUN PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4577
US

IV. Provider business mailing address

5462 WHITTLESEY BLVD APT# 927
COLUMBUS GA
31909-2185
US

V. Phone/Fax

Practice location:
  • Phone: 850-322-0680
  • Fax:
Mailing address:
  • Phone: 850-322-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH025911
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: