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General NPI Number Information
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NPI Number | 1336453984
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Entity Type | Individual
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Provider Name | QUTINA S MACK PHARM D
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Gender | Female
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1310 SOUTHERN AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20032-4623
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Country | US
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Telephone | 202-574-6748
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Fax |
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Provider Business Mailing Address
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Address Line | 10104 SENATE DR
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City | LANHAM
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State | MD
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Zip | 20706-4392
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Country | US
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Telephone | 708-218-6695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19646
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | PH100000746
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License Number State | DC
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