Healthcare Provider Details

I. General information

NPI: 1790054294
Provider Name (Legal Business Name): AMY WIGLESWORTH BRYK PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY KATHRYN WIGLESWORTH PHARM.D

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST CARNEGIE 180
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST CARNEGIE 180
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 443-287-5193
  • Fax:
Mailing address:
  • Phone: 443-287-5193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number056046-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number20342
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number19731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: