Healthcare Provider Details

I. General information

NPI: 1861788978
Provider Name (Legal Business Name): DONNA MARIA PUTKOVICH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6093 SPRING RIDGE PKWY
FREDERICK MD
21701-5898
US

IV. Provider business mailing address

6093 SPRING RIDGE PKWY
FREDERICK MD
21701-5898
US

V. Phone/Fax

Practice location:
  • Phone: 301-631-8160
  • Fax: 301-631-8171
Mailing address:
  • Phone: 301-631-8160
  • Fax: 301-631-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: