Provider Demographics
NPI:1518067149
Name:GUTOWSKI, JOHN M (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:GUTOWSKI
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 1:1622 MAYO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6541
Mailing Address - Country:US
Mailing Address - Phone:305-854-5535
Mailing Address - Fax:305-854-5929
Practice Address - Street 1:1801 CORAL WAY
Practice Address - Street 2:SUITE 115
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2784
Practice Address - Country:US
Practice Address - Phone:305-854-5535
Practice Address - Fax:305-854-5929
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSTATE LICENSE NUMBEROtherPS16809