MEDICARE: OTN PARENT CORP.

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1649458886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTN PARENT CORP.

Provider Business Mailing Address
First Line	:	395 OYSTER POINT BLVD
Second Line	:	#500
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-1928
Country	:	US
Telephone Number	:	415-983-8619
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 OYSTER POINT BLVD
Second Line	:	#500
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-1928
Country	:	US
Telephone Number	:	415-983-8619
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, MCKESSON SPECIALTY
Name	:	PATRICK J BLAKE
Credential	:
Telephone Number	:	415-983-9397

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/08/2008

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Directions to “OTN PARENT CORP. ” Practice Location

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