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General NPI Number Information
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NPI Number | 1235256157
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Entity Type | Organization
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Legal Business Name | OTT AND MCHENRY PHARMACY , INC
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Dates
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Enumeration Date | 03/24/2007
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 102 MAIN ST
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City | BRADFORD
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State | PA
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Zip | 16701-2023
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Country | US
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Telephone | 814-362-3827
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Fax | 814-363-9844
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Provider Business Mailing Address
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Address Line | 102 MAIN ST
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City | BRADFORD
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State | PA
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Zip | 16701-2023
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Country | US
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Telephone | 814-362-3827
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Fax | 814-363-9844
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Authorized Official
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Title or Position | OWNER, RPH
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Name | MICHAEL DOLAN
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Credential |
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Telephone | 814-362-3827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP411739L
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License Number State | PA
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