Provider Demographics
NPI:1033419981
Name:COUTROS, GEORGE W (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:COUTROS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 LONDON TOWNE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6409
Mailing Address - Country:US
Mailing Address - Phone:410-552-1015
Mailing Address - Fax:410-552-3190
Practice Address - Street 1:1313 LONDONTOWN BLVD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6409
Practice Address - Country:US
Practice Address - Phone:410-552-1015
Practice Address - Fax:410-552-3190
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist