Provider Demographics
NPI:1437745486
Name:OTT, KARYN MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:MICHELLE
Last Name:OTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 W KINGSTON LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3123
Mailing Address - Country:US
Mailing Address - Phone:602-931-2780
Mailing Address - Fax:
Practice Address - Street 1:7586 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6077
Practice Address - Country:US
Practice Address - Phone:623-334-2081
Practice Address - Fax:623-334-2083
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist