MEDICARE: DR. CORTNEY JAE PROUTT PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18789	MD

General Provider Information

NPI Number	:	1275762965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORTNEY JAE PROUTT PHARMD

Provider Business Mailing Address
First Line	:	5603 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-1402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5603 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-1402
Country	:	US
Telephone Number	:	410-744-1422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	04/15/2026

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