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General NPI Number Information
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NPI Number | 1740672468
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Entity Type | Individual
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Provider Name | CODY OTERO PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 7494 US HIGHWAY 11
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City | POTSDAM
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State | NY
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Zip | 13676-3577
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Country | US
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Telephone | 315-268-6917
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 364
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City | MADRID
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State | NY
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Zip | 13660-0364
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Country | US
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Telephone | 518-728-2633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 060085
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License Number State | NY
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