Healthcare Provider Details

I. General information

NPI: 1669842019
Provider Name (Legal Business Name): THOMAS OTROBA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 ALPHA DR
PITTSBURGH PA
15238-2819
US

IV. Provider business mailing address

1314 HILLSDALE AVE
PITTSBURGH PA
15216-2502
US

V. Phone/Fax

Practice location:
  • Phone: 412-967-8733
  • Fax:
Mailing address:
  • Phone: 412-977-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449238
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: