Healthcare Provider Details

I. General information

NPI: 1427343672
Provider Name (Legal Business Name): LAWRENCE JOE KOTEY PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 LYONSWOOD DR
OWINGS MILLS MD
21117-4767
US

IV. Provider business mailing address

9505 LYONSWOOD DR
OWINGS MILLS MD
21117-4767
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-8311
  • Fax: 410-356-8311
Mailing address:
  • Phone: 410-356-8311
  • Fax: 410-356-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16918
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: