Provider Demographics
NPI:1477500080
Name:OTTERSENS PHARMECEUTICAL SERVICES
Entity Type:Organization
Organization Name:OTTERSENS PHARMECEUTICAL SERVICES
Other - Org Name:OTTERSENS PHARMACEUTICAL SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUSOUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:206-365-4048
Mailing Address - Street 1:PO BOX 33026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-0026
Mailing Address - Country:US
Mailing Address - Phone:206-365-4048
Mailing Address - Fax:206-365-4096
Practice Address - Street 1:13023 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-7308
Practice Address - Country:US
Practice Address - Phone:206-365-4048
Practice Address - Fax:206-365-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X
WAPHAR.CF.000023613336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6007348Medicaid
2107358OtherPK