Provider Demographics
NPI:1609190958
Name:OTERO, RUTHY R (RPH)
Entity Type:Individual
Prefix:
First Name:RUTHY
Middle Name:R
Last Name:OTERO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5415
Mailing Address - Country:US
Mailing Address - Phone:845-561-4890
Mailing Address - Fax:845-561-7978
Practice Address - Street 1:192 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5415
Practice Address - Country:US
Practice Address - Phone:845-561-4890
Practice Address - Fax:845-561-7978
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037326-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist