Active NPI
Michaela Rose Otterstatter
- Pharmacist
- Ashland, WI
National Provider Identifier
1639797954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20376-40
- Practice address
- 110 Lake Shore Dr W
Ashland, WI 54806-1645 - Phone
- (715) 685-0202
- Fax
- (715) 685-0208
- NPI assigned
- Jul 13, 2020
- Sex
- Female
- 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 | 20376-40 | WI | Primary |
Addresses
Primary practice location
110 Lake Shore Dr W
Ashland, WI 54806-1645
Mailing address
110 Lake Shore Dr W
Ashland, WI 54806-1645
Phone (715) 685-0202
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20376-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
110 Lake Shore Dr W
Ashland, WI 54806
Phone (715) 658-0202
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594598400000",
"number": "1639797954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 LAKE SHORE DR W",
"city": "ASHLAND",
"state": "WI",
"postal_code": "548061645",
"telephone_number": "715-685-0202",
"fax_number": "715-685-0208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LAKE SHORE DR W",
"city": "ASHLAND",
"state": "WI",
"postal_code": "548061645",
"telephone_number": "715-685-0202",
"fax_number": "715-685-0208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTERSTATTER",
"first_name": "MICHAELA",
"middle_name": "ROSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-13",
"last_updated": "2020-07-13",
"certification_date": "2020-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "20376-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ashland, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.