Provider Demographics
NPI:1295458198
Name:COTTER, KELLY (PHARMD, BCPS, CDOE)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:PHARMD, BCPS, CDOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2334
Mailing Address - Country:US
Mailing Address - Phone:774-262-5033
Mailing Address - Fax:
Practice Address - Street 1:197 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2545
Practice Address - Country:US
Practice Address - Phone:508-752-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH2367641835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy