Provider Demographics
NPI:1376893198
Name:SOTTOSANTI, THEODORE LAWRENCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:LAWRENCE
Last Name:SOTTOSANTI
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 1:1515 E ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1637
Mailing Address - Country:US
Mailing Address - Phone:480-755-1944
Mailing Address - Fax:480-777-9621
Practice Address - Street 1:1515 E ELLIOT RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1637
Practice Address - Country:US
Practice Address - Phone:480-755-1944
Practice Address - Fax:480-777-9621
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist