Provider Demographics
NPI:1740672468
Name:OTERO, CODY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:OTERO
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:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:MADRID
Mailing Address - State:NY
Mailing Address - Zip Code:13660-0364
Mailing Address - Country:US
Mailing Address - Phone:518-728-2633
Mailing Address - Fax:
Practice Address - Street 1:7494 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3577
Practice Address - Country:US
Practice Address - Phone:315-268-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist