Provider Demographics
NPI:1548863483
Name:PATOTA, PETER A (PHARMD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:PATOTA
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 1:2110 CRANBERRY COVE PLAZA
Mailing Address - Street 2:ATTN PHARMACY
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653
Mailing Address - Country:US
Mailing Address - Phone:508-255-3851
Mailing Address - Fax:844-411-6212
Practice Address - Street 1:2110 CRANBERRY COVE PLAZA
Practice Address - Street 2:ATTN PHARMACY
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653
Practice Address - Country:US
Practice Address - Phone:508-255-3851
Practice Address - Fax:844-411-6212
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist