Provider Demographics
NPI:1568875904
Name:OTTINGER, DEENA
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:OTTINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 N BORO LINE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2801
Mailing Address - Country:US
Mailing Address - Phone:610-489-3980
Mailing Address - Fax:
Practice Address - Street 1:12 DOUGLASSVILLE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1543
Practice Address - Country:US
Practice Address - Phone:610-385-6643
Practice Address - Fax:610-385-1712
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041783L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist