Provider Demographics
NPI:1003573023
Name:MAVRONIS, STEVE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:MAVRONIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 MOONSTONE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1925
Mailing Address - Country:US
Mailing Address - Phone:410-303-7187
Mailing Address - Fax:
Practice Address - Street 1:1535 PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4280
Practice Address - Country:US
Practice Address - Phone:410-225-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist