Provider Demographics
NPI:1295005957
Name:MOTSKO, JOHN MICHAEL
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MOTSKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4394 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:TYASKIN
Mailing Address - State:MD
Mailing Address - Zip Code:21865
Mailing Address - Country:US
Mailing Address - Phone:410-251-1457
Mailing Address - Fax:410-873-2349
Practice Address - Street 1:404 N. FRUITLAND BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-749-8401
Practice Address - Fax:410-860-1155
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist