Healthcare Provider Details

I. General information

NPI: 1528309051
Provider Name (Legal Business Name): HOWARD SETO GWON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7141 SECURITY BLVD PHARMACY
BALTIMORE MD
21244-1811
US

IV. Provider business mailing address

7141 SECURITY BLVD PHARMACY
BALTIMORE MD
21244-1811
US

V. Phone/Fax

Practice location:
  • Phone: 443-663-6116
  • Fax:
Mailing address:
  • Phone: 443-663-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number09503
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: