Healthcare Provider Details

I. General information

NPI: 1568875904
Provider Name (Legal Business Name): DEENA OTTINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DOUGLASSVILLE SHOPPING CTR
DOUGLASSVILLE PA
19518-1543
US

IV. Provider business mailing address

39 N BORO LINE RD
COLLEGEVILLE PA
19426-2801
US

V. Phone/Fax

Practice location:
  • Phone: 610-385-6643
  • Fax: 610-385-1712
Mailing address:
  • Phone: 610-489-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041783L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: