Healthcare Provider Details

I. General information

NPI: 1366012445
Provider Name (Legal Business Name): CAROLINE ELIZABETH TITUS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL DR STE 107
GLEN BURNIE MD
21061-5861
US

IV. Provider business mailing address

1426 COREY LN
ANNAPOLIS MD
21401-4001
US

V. Phone/Fax

Practice location:
  • Phone: 410-787-0030
  • Fax:
Mailing address:
  • Phone: 443-758-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28142
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPI01712
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: