Provider Demographics
NPI:1770901886
Name:OTT, CHRISTOPHER LEONARD (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEONARD
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 1:1850 W DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2943
Mailing Address - Country:US
Mailing Address - Phone:602-861-1537
Mailing Address - Fax:602-861-1543
Practice Address - Street 1:1850 W DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2943
Practice Address - Country:US
Practice Address - Phone:602-861-1537
Practice Address - Fax:602-861-1543
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist