Provider Demographics
NPI:1427439926
Name:THROWER, OTHA ALVIN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:OTHA
Middle Name:ALVIN
Last Name:THROWER
Suffix:JR
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 1:4847 TRAWLER CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-4038
Mailing Address - Country:US
Mailing Address - Phone:904-646-4636
Mailing Address - Fax:
Practice Address - Street 1:7117 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2620
Practice Address - Country:US
Practice Address - Phone:904-744-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist