Provider Demographics
NPI:1083324859
Name:KOTA, DENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:
Last Name:KOTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 JUBAL PL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6503
Mailing Address - Country:US
Mailing Address - Phone:757-207-6346
Mailing Address - Fax:
Practice Address - Street 1:132 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3374
Practice Address - Country:US
Practice Address - Phone:757-345-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022189411835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care