Healthcare Provider Details

I. General information

NPI: 1013004894
Provider Name (Legal Business Name): STEVEN GERARD OTTARIANO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 SMYTH RD
MANCHESTER NH
03104-4098
US

IV. Provider business mailing address

24 RED DEER RD
LONDONDERRY NH
03053-2609
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4366
  • Fax: 603-626-6562
Mailing address:
  • Phone: 603-434-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1903
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: