Provider Demographics
NPI:1013612704
Name:OTT, DEBRA ANN (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:OTT
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 GEORGE WASHINGTON MEM HWY STE B
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2128
Mailing Address - Country:US
Mailing Address - Phone:757-989-0744
Mailing Address - Fax:757-989-3014
Practice Address - Street 1:6500 GEORGE WASHINGTON MEM HWY STE B
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2128
Practice Address - Country:US
Practice Address - Phone:757-513-2728
Practice Address - Fax:757-989-3014
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230003615183700000X
VA0230002615183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician