Basic Information
| Provider Information | |||||||||
| NPI: | 1922160662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NETT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | OTTO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMACIST | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 576 JEFFERSON AVENUE | ||||||||
| Address2: | |||||||||
| City: | FORT EUSTIS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236045548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572585316 | ||||||||
| FaxNumber: | 7573147764 | ||||||||
| Practice Location | |||||||||
| Address1: | 576 JEFFERSON AVENUE | ||||||||
| Address2: | |||||||||
| City: | FORT EUSTIS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236045548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572585316 | ||||||||
| FaxNumber: | 7573147764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 0202011431 | VA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.