Healthcare Provider Details

I. General information

NPI: 1962802033
Provider Name (Legal Business Name): ANDREW SKALKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S EXETER ST
BALTIMORE MD
21202-4316
US

IV. Provider business mailing address

9445 DUNLOGGIN RD
ELLICOTT CITY MD
21042-5115
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-6520
  • Fax:
Mailing address:
  • Phone: 410-303-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: