Provider Demographics
NPI:1629688577
Name:OTTING, MICHAELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:OTTING
Suffix:
Gender:F
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-0067
Mailing Address - Country:US
Mailing Address - Phone:563-557-2950
Mailing Address - Fax:563-557-2955
Practice Address - Street 1:8456 PEOSTA COMMERCIAL CT
Practice Address - Street 2:
Practice Address - City:PEOSTA
Practice Address - State:IA
Practice Address - Zip Code:52068-7123
Practice Address - Country:US
Practice Address - Phone:563-557-2950
Practice Address - Fax:563-557-2955
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist