Healthcare Provider Details

I. General information

NPI: 1609158690
Provider Name (Legal Business Name): MICHELLE OTTEY URBAN PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 NC HIGHWAY 50 # 210 SUITE 101
SURF CITY NC
28445-7934
US

IV. Provider business mailing address

13500 NC 50/210 SUITE 101
SURF CITY NC
28445
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-1134
  • Fax: 910-329-1175
Mailing address:
  • Phone: 910-329-1134
  • Fax: 910-329-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18323
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: