Healthcare Provider Details

I. General information

NPI: 1154618148
Provider Name (Legal Business Name): MICHAEL C OTT PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

59 RANDWOOD CT
GETZVILLE NY
14068-1333
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-4724
  • Fax: 716-898-4666
Mailing address:
  • Phone: 716-984-7605
  • Fax: 716-898-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number040619
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-26533
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: