Provider Demographics
NPI:1912929050
Name:LOETELL, JOSEPH WILMER JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WILMER
Last Name:LOETELL
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13803 SEA CAPTAIN RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-5826
Mailing Address - Country:US
Mailing Address - Phone:410-250-0185
Mailing Address - Fax:
Practice Address - Street 1:13803 SEA CAPTAIN RD
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-5826
Practice Address - Country:US
Practice Address - Phone:410-250-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05872183500000X
DEA10003277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist