Provider Demographics
NPI:1194455196
Name:OTHELLO, DAYAMIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAYAMIE
Middle Name:
Last Name:OTHELLO
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 1:4444 DEMETROPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-9602
Mailing Address - Country:US
Mailing Address - Phone:251-219-3900
Mailing Address - Fax:
Practice Address - Street 1:4444 DEMETROPOLIS RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-9602
Practice Address - Country:US
Practice Address - Phone:251-574-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS627131835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist