Healthcare Provider Details

I. General information

NPI: 1871533489
Provider Name (Legal Business Name): CHANEL F AGNESS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N PINE ST PPS DEPARTMENT, ROOM 415
BALTIMORE MD
21201-1142
US

IV. Provider business mailing address

20 NORTH PINE STREET PPS DEPARTMENT, ROOM 415
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-5535
  • Fax: 410-706-4725
Mailing address:
  • Phone: 410-706-5535
  • Fax: 410-706-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16845
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: