MEDICARE: MICHAEL PELOQUIN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	17003	MD

General Provider Information

NPI Number	:	1770982027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PELOQUIN PHARMD

Provider Business Mailing Address
First Line	:	110 WALKERS VILLAGE WAY
Second Line	:
City	:	WALKERSVILLE
State	:	MD
Zip	:	21793-8147
Country	:	US
Telephone Number	:	301-845-2811
Fax Number	:	301-845-0268

Provider Business Practice Location Address
First Line	:	110 WALKERS VILLAGE WAY
Second Line	:
City	:	WALKERSVILLE
State	:	MD
Zip	:	21793-8147
Country	:	US
Telephone Number	:	301-845-2811
Fax Number	:	301-845-0268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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