Healthcare Provider Details

I. General information

NPI: 1306560891
Provider Name (Legal Business Name): EMILIE PAUL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6229 LATCHLIFT CT
ELKRIDGE MD
21075-6916
US

IV. Provider business mailing address

6229 LATCHLIFT CT
ELKRIDGE MD
21075-6916
US

V. Phone/Fax

Practice location:
  • Phone: 410-493-0900
  • Fax:
Mailing address:
  • Phone: 410-493-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number16019
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number16019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: