Provider Demographics
NPI:1730597667
Name:OTTUN, NATOURI (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:NATOURI
Middle Name:
Last Name:OTTUN
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5462 WHITTLESEY BLVD
Mailing Address - Street 2:APT# 927
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2185
Mailing Address - Country:US
Mailing Address - Phone:850-322-0680
Mailing Address - Fax:
Practice Address - Street 1:1100 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4577
Practice Address - Country:US
Practice Address - Phone:850-322-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0259111835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy