Basic Information
| Provider Information | |||||||||
| NPI: | 1851370514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAFTARIAN | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILTROUT | ||||||||
| OtherFirstName: | JOYCE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 47149 BUSE RD | ||||||||
| Address2: | BLDG 1370 | ||||||||
| City: | PATUXENT RIVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206701540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013429503 | ||||||||
| FaxNumber: | 3013424718 | ||||||||
| Practice Location | |||||||||
| Address1: | 47149 BUSE RD | ||||||||
| Address2: | BLDG 1370 | ||||||||
| City: | PATUXENT RIVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206701540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013429503 | ||||||||
| FaxNumber: | 3013424718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 17131 | MD | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.