Healthcare Provider Details

I. General information

NPI: 1275530081
Provider Name (Legal Business Name): MARIE A MACKOWICK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

IV. Provider business mailing address

1213 FAIRFIELD ESTATES LN
CROWNSVILLE MD
21032-2033
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3167
  • Fax: 410-724-3169
Mailing address:
  • Phone: 410-923-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number09749
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: