Active NPI
Justin Otting, PHARMD, RPH
- Pharmacist
- McKinleyville, CA
National Provider Identifier
1508238213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 72356
- Practice address
- 1567 City Center Rd
McKinleyville, CA 95519-3600 - Phone
- (707) 633-4884
- Fax
- (888) 810-1949
- NPI assigned
- Oct 21, 2015
- Last updated
- Jun 17, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 | 72356 | CA | Primary |
Addresses
Primary practice location
1567 City Center Rd
McKinleyville, CA 95519-3600
Mailing address
1567 City Center Rd
McKinleyville, CA 95519-3600
Phone (707) 633-4884
Other practice location 1
1720 Central Ave
McKinleyville, CA 95519-3602
Phone (707) 839-5621
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
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72356 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients | |
| Redwood Community Pharmacy | Past | Accepting new patients |
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.
-
- Community/Retail Pharmacy
- McKinleyville, CA
- NPI 1790436269
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655424000000",
"number": "1508238213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1567 CITY CENTER RD",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955193600",
"telephone_number": "707-633-4884",
"fax_number": "707-839-2867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1567 CITY CENTER RD",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955193600",
"telephone_number": "707-633-4884",
"fax_number": "888-810-1949"
}
],
"practiceLocations": [
{
"address_1": "1720 Central Ave",
"address_purpose": "LOCATION",
"city": "McKinleyville",
"state": "CA",
"postal_code": "955193602",
"country_code": "US",
"telephone_number": "707-839-5621",
"fax_number": "707-839-2867",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OTTING",
"first_name": "JUSTIN",
"credential": "PHARMD, RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-21",
"last_updated": "2022-06-17",
"certification_date": "2022-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "72356",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McKinleyville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.