Provider Demographics
NPI:1467722207
Name:OTERI, KELVIN ATEGHO (B PHARM)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:ATEGHO
Last Name:OTERI
Suffix:
Gender:M
Credentials:B PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 LEBANON CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7197
Mailing Address - Country:US
Mailing Address - Phone:407-431-3691
Mailing Address - Fax:
Practice Address - Street 1:408 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4542
Practice Address - Country:US
Practice Address - Phone:407-843-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist