Healthcare Provider Details

I. General information

NPI: 1346558293
Provider Name (Legal Business Name): DAVID ALAN KOTZIN RPH,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 CROFTON CTR
CROFTON MD
21114-1330
US

IV. Provider business mailing address

1649 CROFTON CTR
CROFTON MD
21114-1330
US

V. Phone/Fax

Practice location:
  • Phone: 410-793-0325
  • Fax: 410-793-0357
Mailing address:
  • Phone: 410-793-0325
  • Fax: 410-793-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10932
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: