Healthcare Provider Details

I. General information

NPI: 1053898148
Provider Name (Legal Business Name): TERRILYN MICHELE KOTISHION RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PLUMTREE RD STE A
BEL AIR MD
21015-6056
US

IV. Provider business mailing address

1110 SPARROW MILL WAY
BEL AIR MD
21015-6134
US

V. Phone/Fax

Practice location:
  • Phone: 410-670-3719
  • Fax: 410-670-3751
Mailing address:
  • Phone: 410-375-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11453
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: