Provider Demographics
NPI:1326497314
Name:OTT, ZACHARY BRANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:BRANDON
Last Name:OTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 WIMBLEDON DR
Mailing Address - Street 2:APT 108
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5355
Mailing Address - Country:US
Mailing Address - Phone:803-834-2896
Mailing Address - Fax:
Practice Address - Street 1:1540 WIMBLEDON DR
Practice Address - Street 2:APT 108
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5355
Practice Address - Country:US
Practice Address - Phone:803-834-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist