Healthcare Provider Details

I. General information

NPI: 1851498190
Provider Name (Legal Business Name): STANLEY WALTER GUTOWSKI JR. RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC PERRY POINT BLDG 361- PHARMACY
PERRY POINT MD
21902-1045
US

IV. Provider business mailing address

309 ROUNDHOUSE DR
PERRYVILLE MD
21903-3040
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-1089
  • Fax: 410-642-1122
Mailing address:
  • Phone: 443-206-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07299
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: