Provider Demographics
NPI:1669044426
Name:BROCATO, ANTHONY JR (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BROCATO
Suffix:JR
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 1:3 ELPHIN CT UNIT 301
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-7730
Mailing Address - Country:US
Mailing Address - Phone:410-838-8024
Mailing Address - Fax:
Practice Address - Street 1:907 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2273
Practice Address - Country:US
Practice Address - Phone:410-239-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist