Healthcare Provider Details

I. General information

NPI: 1477500080
Provider Name (Legal Business Name): OTTERSENS PHARMECEUTICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13023 GREENWOOD AVE N
SEATTLE WA
98133-7308
US

IV. Provider business mailing address

PO BOX 33026
SEATTLE WA
98133-0026
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-4048
  • Fax: 206-365-4096
Mailing address:
  • Phone: 206-365-4048
  • Fax: 206-365-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR.CF.00002361
License Number StateWA

VIII. Authorized Official

Name: SONYA KOUSOUM
Title or Position: PHARMACIST MANAGER
Credential: PHARMD
Phone: 206-365-4048