Healthcare Provider Details

I. General information

NPI: 1790505238
Provider Name (Legal Business Name): SOPHIA M COMI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7077 ARUNDEL MILLS CIR
HANOVER MD
21076-1387
US

IV. Provider business mailing address

7077 ARUNDEL MILLS CIR
HANOVER MD
21076-1387
US

V. Phone/Fax

Practice location:
  • Phone: 410-379-3102
  • Fax: 410-379-3121
Mailing address:
  • Phone: 410-379-3102
  • Fax: 410-379-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30086
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number30086
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: