MEDICARE: ANDREW SKALKA

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	21865	MD

General Provider Information

NPI Number	:	1962802033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SKALKA

Provider Business Mailing Address
First Line	:	9445 DUNLOGGIN RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-5115
Country	:	US
Telephone Number	:	410-303-6234
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 S EXETER ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4316
Country	:	US
Telephone Number	:	410-962-6520
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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