Provider Demographics
NPI:1154426948
Name:MOTTRAM, CHRIS C (RPH)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:C
Last Name:MOTTRAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N LIME AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6120
Mailing Address - Country:US
Mailing Address - Phone:941-366-2424
Mailing Address - Fax:941-296-7360
Practice Address - Street 1:24 N LIME AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6120
Practice Address - Country:US
Practice Address - Phone:941-366-2424
Practice Address - Fax:941-954-6043
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0019506OtherLICENSE NUMBER