Provider Demographics
NPI:1275789760
Name:OTTNEY, ANNE RENAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:RENAE
Last Name:OTTNEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:RENAE
Other - Last Name:KORENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 245A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-364-5459
Mailing Address - Fax:517-364-5717
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 245A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5459
Practice Address - Fax:517-364-5717
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND51801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist