Provider Demographics
NPI:1639454143
Name:OTT, DONALD (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:OTT
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 1:780 WAUKEGAN RD
Mailing Address - Street 2:WALGREENS
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4305
Mailing Address - Country:US
Mailing Address - Phone:847-945-0611
Mailing Address - Fax:
Practice Address - Street 1:780 WAUKEGAN RD
Practice Address - Street 2:WALGREENS
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4305
Practice Address - Country:US
Practice Address - Phone:847-945-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.033651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist