Provider Demographics
NPI:1821474883
Name:OTERO-SALVATELLA, BENJAMIN JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:OTERO-SALVATELLA
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 VAN GOGH WAY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1580
Mailing Address - Country:US
Mailing Address - Phone:561-236-6046
Mailing Address - Fax:
Practice Address - Street 1:1010 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:FL
Practice Address - Zip Code:33409-6011
Practice Address - Country:US
Practice Address - Phone:561-471-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53761183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist