Provider Demographics
NPI:1750501110
Name:PYCHA, JOHN JEROME (PD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JEROME
Last Name:PYCHA
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13612 BROOKLINE RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9761
Mailing Address - Country:US
Mailing Address - Phone:410-592-2252
Mailing Address - Fax:
Practice Address - Street 1:3320 PAPER MILL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1419
Practice Address - Country:US
Practice Address - Phone:410-667-4600
Practice Address - Fax:410-667-4716
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist