Provider Demographics
NPI:1346558293
Name:KOTZIN, DAVID ALAN (RPH,MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:KOTZIN
Suffix:
Gender:M
Credentials:RPH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 CROFTON CTR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1330
Mailing Address - Country:US
Mailing Address - Phone:410-793-0325
Mailing Address - Fax:410-793-0357
Practice Address - Street 1:1649 CROFTON CTR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1330
Practice Address - Country:US
Practice Address - Phone:410-793-0325
Practice Address - Fax:410-793-0357
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10932OtherPHARMACY LICENSE