Healthcare Provider Details

I. General information

NPI: 1770982027
Provider Name (Legal Business Name): MICHAEL PELOQUIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WALKERS VILLAGE WAY
WALKERSVILLE MD
21793-8147
US

IV. Provider business mailing address

110 WALKERS VILLAGE WAY
WALKERSVILLE MD
21793-8147
US

V. Phone/Fax

Practice location:
  • Phone: 301-845-2811
  • Fax: 301-845-0268
Mailing address:
  • Phone: 301-845-2811
  • Fax: 301-845-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17003
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: