Provider Demographics
NPI:1407146426
Name:OTTERBURN, CATHERINE
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:OTTERBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7404
Mailing Address - Country:US
Mailing Address - Phone:804-282-4219
Mailing Address - Fax:804-282-8241
Practice Address - Street 1:450 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-7404
Practice Address - Country:US
Practice Address - Phone:804-282-4219
Practice Address - Fax:804-282-8241
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist