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Individual

SU SO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2945
(443) 444-4760
Mailing address
5622 WATERLOO RD, COLUMBIA, MD 21045-2627

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
22816
MD
183500000X
Pharmacist
RP449022
PA

Other

Enumeration date
08/11/2014
Last updated
02/11/2015
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