Healthcare Provider Details

I. General information

NPI: 1780291112
Provider Name (Legal Business Name): SIMON K MURAGURI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 E COLD SPRING LN STE B
BALTIMORE MD
21239-3913
US

IV. Provider business mailing address

4609 RIDDLE DR
NOTTINGHAM MD
21236-5702
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-4886
  • Fax:
Mailing address:
  • Phone: 410-274-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26428
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: