Provider Demographics
NPI:1881994952
Name:COUTROS, VICKI L (PD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:COUTROS
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8032C LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3239
Mailing Address - Country:US
Mailing Address - Phone:301-846-0090
Mailing Address - Fax:301-846-7761
Practice Address - Street 1:8032C LIBERTY RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-3239
Practice Address - Country:US
Practice Address - Phone:301-846-0090
Practice Address - Fax:301-846-7761
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist