Provider Demographics
NPI:1801200258
Name:DRUTCH, PATRICIA CAPOTOSTO
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CAPOTOSTO
Last Name:DRUTCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 PAUL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3771
Mailing Address - Country:US
Mailing Address - Phone:410-750-2148
Mailing Address - Fax:
Practice Address - Street 1:10000 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SAFEWAY PHARMACY
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3612
Practice Address - Country:US
Practice Address - Phone:410-750-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD611800OtherNABP E-PROFILE
MD11365OtherMARYLAND STATE BOARD OF PHARMACY