Active NPI
Jason Dean Otta, RPH
- Pharmacist
- Sioux Falls, SD
National Provider Identifier
1104266469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4853
- Practice address
- 3201 S Louise Ave
Sioux Falls, SD 57106-0704 - Phone
- (605) 362-2625
- Fax
- (605) 362-2636
- NPI assigned
- Jul 1, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 4853 | SD | Primary |
Addresses
Primary practice location
3201 S Louise Ave
Sioux Falls, SD 57106-0704
Mailing address
1201 Hyannis Port LN
Sioux Falls, SD 57106-5467
Phone (605) 362-6653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4853 | SD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372636800000",
"number": "1104266469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 HYANNIS PORT LN",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571065467",
"telephone_number": "605-362-6653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 S LOUISE AVE",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571060704",
"telephone_number": "605-362-2625",
"fax_number": "605-362-2636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTA",
"first_name": "JASON",
"middle_name": "DEAN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-01",
"last_updated": "2013-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SD",
"license": "4853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sioux Falls, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.