Healthcare Provider Details

I. General information

NPI: 1578681367
Provider Name (Legal Business Name): REGINA MULJADI PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

221 OWINGS GATE CT APT 302
OWINGS MILLS MD
21117-4780
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-8882
  • Fax:
Mailing address:
  • Phone: 410-601-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number17248
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: