Provider Demographics
NPI:1619316114
Name:MOTTELER, AUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:MOTTELER
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 1:1125 WEST NC 54 HWY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:919-403-8053
Mailing Address - Fax:919-490-1421
Practice Address - Street 1:1125 W NC 54 HWY
Practice Address - Street 2:STE 310
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-0000
Practice Address - Country:US
Practice Address - Phone:919-403-8053
Practice Address - Fax:919-490-1421
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist