Active NPI
Mary A. Otis, RPH
- Pharmacist
- Highland, IL
National Provider Identifier
1134492812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 51-028503
- Practice address
- 280 Kingsbury CT
Highland, IL 62249-2921 - Phone
- (618) 654-5469
- NPI assigned
- Feb 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 51-028503 | IL | Primary |
| Pharmacist | 183500000X | 027995 | MO |
Addresses
Primary practice location
280 Kingsbury CT
Highland, IL 62249-2921
Mailing address
280 Kingsbury CT
Highland, IL 62249-2921
Phone (618) 654-5469
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 |
|---|---|---|---|
| 51-028503 | IL | MD | Pharmacist |
| 027995 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328918400000",
"number": "1134492812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "280 KINGSBURY CT",
"city": "HIGHLAND",
"state": "IL",
"postal_code": "622492921",
"telephone_number": "618-654-5469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 KINGSBURY CT",
"city": "HIGHLAND",
"state": "IL",
"postal_code": "622492921",
"telephone_number": "618-654-5469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTIS",
"first_name": "MARY",
"middle_name": "A.",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-11",
"last_updated": "2012-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "51-028503",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "027995",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Highland, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.