Healthcare Provider Details

I. General information

NPI: 1104672518
Provider Name (Legal Business Name): MARC GUTOWSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

IV. Provider business mailing address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

V. Phone/Fax

Practice location:
  • Phone: 412-246-6104
  • Fax: 412-246-6110
Mailing address:
  • Phone: 412-246-6104
  • Fax: 412-246-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP440085
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: