Provider Demographics
NPI:1497436901
Name:OTANI, TERRENCE NAOTO
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:NAOTO
Last Name:OTANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6185 SHAMROCK CT STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-1275
Mailing Address - Country:US
Mailing Address - Phone:614-647-5115
Mailing Address - Fax:380-204-7905
Practice Address - Street 1:6185 SHAMROCK CT STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-1275
Practice Address - Country:US
Practice Address - Phone:614-647-5115
Practice Address - Fax:380-204-7905
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03316143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist