Provider Demographics
NPI:1205207727
Name:OTT, JOCELYN ANNE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:JOCELYN
Middle Name:ANNE
Last Name:OTT
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 1:1222 MAPLE TREE DR
Mailing Address - Street 2:301
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9170
Mailing Address - Country:US
Mailing Address - Phone:814-553-8115
Mailing Address - Fax:
Practice Address - Street 1:1222 MAPLE TREE DR
Practice Address - Street 2:301
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9170
Practice Address - Country:US
Practice Address - Phone:814-553-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist