Provider Demographics
NPI:1699182600
Name:OTT, SEAN RUSSEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:RUSSEL
Last Name:OTT
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 1:330 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-6554
Mailing Address - Country:US
Mailing Address - Phone:828-287-3026
Mailing Address - Fax:828-287-3026
Practice Address - Street 1:197 PLAZA DR
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3712
Practice Address - Country:US
Practice Address - Phone:828-287-3026
Practice Address - Fax:828-287-3026
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist