Provider Demographics
NPI:1265755870
Name:OTTEN, MELANIE JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:JEAN
Last Name:OTTEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 WESTERN AVE
Mailing Address - Street 2:CVS PHARMACY
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-869-0657
Mailing Address - Fax:518-456-8761
Practice Address - Street 1:2040 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5012
Practice Address - Country:US
Practice Address - Phone:518-869-0657
Practice Address - Fax:518-456-8761
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049217-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist