Provider Demographics
NPI:1760167647
Name:COTTA, ALLISON ANN (IMMUNIZING CPHT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:ANN
Last Name:COTTA
Suffix:
Gender:F
Credentials:IMMUNIZING CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHECKO CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1815
Mailing Address - Country:US
Mailing Address - Phone:304-620-1138
Mailing Address - Fax:
Practice Address - Street 1:1102 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3603
Practice Address - Country:US
Practice Address - Phone:304-260-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT27597183700000X
WVPT0011200183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician