Healthcare Provider Details

I. General information

NPI: 1336850148
Provider Name (Legal Business Name): EUNICE KIM KUACK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6383 TEN OAKS RD
CLARKSVILLE MD
21029-1104
US

IV. Provider business mailing address

6383 TEN OAKS RD
CLARKSVILLE MD
21029-1104
US

V. Phone/Fax

Practice location:
  • Phone: 443-535-8339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28981
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: