Provider Demographics
NPI:1386284867
Name:TCHATCHOA, GERALD WATAT (PHARMACIS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:WATAT
Last Name:TCHATCHOA
Suffix:
Gender:M
Credentials:PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9661 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3887
Mailing Address - Country:US
Mailing Address - Phone:240-470-9757
Mailing Address - Fax:
Practice Address - Street 1:6 CARROLL ISLAND RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-2206
Practice Address - Country:US
Practice Address - Phone:410-335-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist