Healthcare Provider Details

I. General information

NPI: 1295005957
Provider Name (Legal Business Name): MR. JOHN MICHAEL MOTSKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N. FRUITLAND BLVD
SALISBURY MD
21801
US

IV. Provider business mailing address

4394 SUNSET DRIVE
TYASKIN MD
21865
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-8401
  • Fax: 410-860-1155
Mailing address:
  • Phone: 410-251-1457
  • Fax: 410-873-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07133
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: