Active NPI
Glenn Otake, RPH
- Pharmacist
- San Antonio, TX
National Provider Identifier
1134460009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28645
- Practice address
- 9238 N Loop 1604 W
San Antonio, TX 78249-2577 - Phone
- (210) 682-3419
- Fax
- (210) 521-5184
- NPI assigned
- Mar 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 | 28645 | TX | Primary |
Addresses
Primary practice location
9238 N Loop 1604 W
San Antonio, TX 78249-2577
Mailing address
8523 Braun KNL
San Antonio, TX 78254-5584
Phone (210) 844-9426
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 |
|---|---|---|---|
| 28645 | TX | MD | Pharmacist |
Practice roles
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362096000000",
"number": "1134460009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8523 BRAUN KNL",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782545584",
"telephone_number": "210-844-9426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9238 N LOOP 1604 W",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782492577",
"telephone_number": "210-682-3419",
"fax_number": "210-521-5184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTAKE",
"first_name": "GLENN",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-01",
"last_updated": "2013-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "28645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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.