Provider Demographics
NPI:1558613588
Name:COTTMAN, DONALD (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:COTTMAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6189 RIVERBANK CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2524
Mailing Address - Country:US
Mailing Address - Phone:209-271-5394
Mailing Address - Fax:
Practice Address - Street 1:6189 RIVERBANK CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2524
Practice Address - Country:US
Practice Address - Phone:209-271-5394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist