Healthcare Provider Details

I. General information

NPI: 1760776157
Provider Name (Legal Business Name): PETER T MBI PHARM.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MONTPELIER RD
LAUREL MD
20723-6012
US

IV. Provider business mailing address

7500 MONTPELIER RD STE 106
LAUREL MD
20723-6012
US

V. Phone/Fax

Practice location:
  • Phone: 240-786-6045
  • Fax: 240-786-6054
Mailing address:
  • Phone: 240-786-6045
  • Fax: 240-786-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0002390
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12341
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: