Provider Demographics
NPI:1104053131
Name:COUTROS, JOHN A (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:COUTROS
Suffix:
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 1:81 CREEK RD
Mailing Address - Street 2:PO BOX 31
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914
Mailing Address - Country:US
Mailing Address - Phone:215-822-7930
Mailing Address - Fax:215-628-4404
Practice Address - Street 1:1650 LIMEKILN PIKE
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1114
Practice Address - Country:US
Practice Address - Phone:215-628-4404
Practice Address - Fax:215-628-3620
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-030407L183500000X
NJ28RI01530100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist