Healthcare Provider Details

I. General information

NPI: 1184927360
Provider Name (Legal Business Name): ANDREW NEIL MICHAELSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5657 BALTIMORE NATIONAL PIKE
CATONSVILLE MD
21228-1412
US

IV. Provider business mailing address

5657 BALTIMORE NATIONAL PIKE
CATONSVILLE MD
21228-1412
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-1054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19701
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: