Provider Demographics
NPI:1861777476
Name:OTTESON, JEREMY AARON (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:AARON
Last Name:OTTESON
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 1:1150 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3838
Mailing Address - Country:US
Mailing Address - Phone:406-442-1265
Mailing Address - Fax:406-442-6417
Practice Address - Street 1:1150 11TH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3838
Practice Address - Country:US
Practice Address - Phone:406-442-1265
Practice Address - Fax:406-442-6417
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist