Healthcare Provider Details

I. General information

NPI: 1508683228
Provider Name (Legal Business Name): JACQUELYN ANNE KOTTEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHNSON RD STE 1054100
STEUBENVILLE OH
43952-2356
US

IV. Provider business mailing address

2433 WYLIE RIDGE RD
WEIRTON WV
26062-6051
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-8222
  • Fax: 740-264-8233
Mailing address:
  • Phone: 304-670-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: