Healthcare Provider Details

I. General information

NPI: 1174934673
Provider Name (Legal Business Name): CLIFTON T PERKINS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
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

8450 DORSEY RUN RD
JESSUP MD
20794-9486
US

V. Phone/Fax

Practice location:
  • Phone: 410-724-3168
  • Fax: 410-724-3169
Mailing address:
  • Phone: 410-724-3168
  • Fax: 410-724-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberP00561
License Number StateMD

VIII. Authorized Official

Name: MARIE MACKOWICK
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 410-724-3167