Provider Demographics
NPI:1053898148
Name:KOTISHION, TERRILYN MICHELE (RPH)
Entity type:Individual
Prefix:
First Name:TERRILYN
Middle Name:MICHELE
Last Name:KOTISHION
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 SPARROW MILL WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6134
Mailing Address - Country:US
Mailing Address - Phone:410-375-4983
Mailing Address - Fax:
Practice Address - Street 1:208 PLUMTREE RD STE A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6056
Practice Address - Country:US
Practice Address - Phone:410-670-3719
Practice Address - Fax:410-670-3751
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11453OtherPHARMACIST LICENSE