Provider Demographics
NPI:1699002857
Name:OTERO, JUDE JONATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:JONATHAN
Last Name:OTERO
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 1:1975 S ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6905
Mailing Address - Country:US
Mailing Address - Phone:480-722-1780
Mailing Address - Fax:
Practice Address - Street 1:1975 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6905
Practice Address - Country:US
Practice Address - Phone:480-722-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007354183500000X
AZS017765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist