Provider Demographics
NPI:1508683228
Name:KOTTEN, JACQUELYN ANNE (RPH)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ANNE
Last Name:KOTTEN
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 1:2433 WYLIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-6051
Mailing Address - Country:US
Mailing Address - Phone:304-670-9174
Mailing Address - Fax:
Practice Address - Street 1:4100 JOHNSON RD STE 1054100
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2356
Practice Address - Country:US
Practice Address - Phone:740-264-8222
Practice Address - Fax:740-264-8233
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist