Provider Demographics
NPI:1215533880
Name:UNKOW, OTSCHIR
Entity Type:Individual
Prefix:
First Name:OTSCHIR
Middle Name:
Last Name:UNKOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08322-3922
Mailing Address - Country:US
Mailing Address - Phone:609-254-5962
Mailing Address - Fax:
Practice Address - Street 1:604 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08322-3922
Practice Address - Country:US
Practice Address - Phone:609-254-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO1511700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist