1821474883 NPI number — DR. BENJAMIN OTERO-SALVATELLA JR. PHARM D

Table of content: DR. BENJAMIN OTERO-SALVATELLA JR. PHARM D (NPI 1821474883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821474883 NPI number — DR. BENJAMIN OTERO-SALVATELLA JR. PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTERO-SALVATELLA
Provider First Name:
BENJAMIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821474883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 VAN GOGH WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROYAL PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33411-1580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-236-6046
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 N MILITARY TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33409-6011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-471-1655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS53761 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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