Provider Demographics
NPI:1619235066
Name:OTTAVIANO, PETER (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:OTTAVIANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6617
Mailing Address - Country:US
Mailing Address - Phone:207-623-1414
Mailing Address - Fax:
Practice Address - Street 1:83 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6617
Practice Address - Country:US
Practice Address - Phone:207-623-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4675183500000X
NH3057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist