MEDICARE: DR. MICHELLE OTTEY URBAN PHARMD, RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18323	NC

General Provider Information

NPI Number	:	1609158690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE OTTEY URBAN PHARMD, RPH

Provider Business Mailing Address
First Line	:	13500 NC 50/210
Second Line	:	SUITE 101
City	:	SURF CITY
State	:	NC
Zip	:	28445
Country	:	US
Telephone Number	:	910-329-1134
Fax Number	:	910-329-1175

Provider Business Practice Location Address
First Line	:	13500 NC HIGHWAY 50 # 210
Second Line	:	SUITE 101
City	:	SURF CITY
State	:	NC
Zip	:	28445-7934
Country	:	US
Telephone Number	:	910-329-1134
Fax Number	:	910-329-1175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	08/18/2014

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