Provider Demographics
NPI:1487084372
Name:OTTARSON, DEBRA LEIGH (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEIGH
Last Name:OTTARSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:WARE NECK
Mailing Address - State:VA
Mailing Address - Zip Code:23178-0112
Mailing Address - Country:US
Mailing Address - Phone:804-693-4336
Mailing Address - Fax:
Practice Address - Street 1:6634 JARVIS ROAD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061
Practice Address - Country:US
Practice Address - Phone:804-693-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist