Provider Demographics
NPI:1720498017
Name:OTHMER, CHRISTIN (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:OTHMER
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 1:10247 COATS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48897-9740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1167 E CLINTON TRL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-7318
Practice Address - Country:US
Practice Address - Phone:517-541-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020318691835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy