Provider Demographics
NPI:1659652857
Name:OTT, JOYCE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARIE
Last Name:OTT
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 1:1905 N JACKSON ST
Mailing Address - Street 2:STE. 500
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2200
Mailing Address - Country:US
Mailing Address - Phone:931-454-0482
Mailing Address - Fax:931-461-1191
Practice Address - Street 1:1905 N JACKSON ST
Practice Address - Street 2:STE. 500
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2200
Practice Address - Country:US
Practice Address - Phone:931-454-0482
Practice Address - Fax:931-461-1191
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034109183500000X
IN26018310A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist