Provider Demographics
NPI:1619220183
Name:OTT-HOLLAND, JEREMY RICHARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:RICHARD
Last Name:OTT-HOLLAND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HILLDALE WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2644
Mailing Address - Country:US
Mailing Address - Phone:608-807-3979
Mailing Address - Fax:
Practice Address - Street 1:750 HILLDALE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2644
Practice Address - Country:US
Practice Address - Phone:608-807-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041433183500000X
WI16302-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist