Provider Demographics
NPI:1235676263
Name:OTT, ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
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 1:117 MAIN AVE E
Mailing Address - Street 2:PO BOX 577
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-8735
Mailing Address - Country:US
Mailing Address - Phone:218-246-8642
Mailing Address - Fax:218-246-9328
Practice Address - Street 1:2 DIVISION ST
Practice Address - Street 2:
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-8779
Practice Address - Country:US
Practice Address - Phone:218-246-8642
Practice Address - Fax:218-246-9328
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist