Healthcare Provider Details

I. General information

NPI: 1265793186
Provider Name (Legal Business Name): KEVIN MICHAEL NORK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 HARFORD RD
BALTIMORE MD
21234-7707
US

IV. Provider business mailing address

314 ROSSLARE DR
ARNOLD MD
21012-3006
US

V. Phone/Fax

Practice location:
  • Phone: 410-254-2055
  • Fax: 410-254-0468
Mailing address:
  • Phone: 443-915-0515
  • Fax: 410-254-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20630
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number20630
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: