Provider Demographics
NPI:1235256157
Name:OTT AND MCHENRY PHARMACY , INC
Entity Type:Organization
Organization Name:OTT AND MCHENRY PHARMACY , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, RPH
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-362-3827
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2023
Mailing Address - Country:US
Mailing Address - Phone:814-362-3827
Mailing Address - Fax:814-363-9844
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2023
Practice Address - Country:US
Practice Address - Phone:814-362-3827
Practice Address - Fax:814-363-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411739L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102152944Medicaid
PA6127040001Medicare NSC