Healthcare Provider Details

I. General information

NPI: 1013477173
Provider Name (Legal Business Name): BRIAN C SUMLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 RIVERSIDE PKWY
BELCAMP MD
21017-1388
US

IV. Provider business mailing address

1321 RIVERSIDE PKWY
BELCAMP MD
21017-1388
US

V. Phone/Fax

Practice location:
  • Phone: 410-272-1810
  • Fax: 410-297-2276
Mailing address:
  • Phone: 410-272-1810
  • Fax: 410-297-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11174
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberMD11174
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: