Provider Demographics
NPI:1851498190
Name:GUTOWSKI, STANLEY WALTER JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:WALTER
Last Name:GUTOWSKI
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 1:309 ROUNDHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-3040
Mailing Address - Country:US
Mailing Address - Phone:443-206-1099
Mailing Address - Fax:
Practice Address - Street 1:VAMC PERRY POINT
Practice Address - Street 2:BLDG 361- PHARMACY
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902-1045
Practice Address - Country:US
Practice Address - Phone:410-642-1089
Practice Address - Fax:410-642-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist