Provider Demographics
NPI:1326821182
Name:OTT, NOLAN WILLIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:WILLIAM
Last Name:OTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-2308
Mailing Address - Country:US
Mailing Address - Phone:570-506-9387
Mailing Address - Fax:
Practice Address - Street 1:1015 N VINE ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2025
Practice Address - Country:US
Practice Address - Phone:570-802-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist