Provider Demographics
NPI:1033436894
Name:ALTSHULER, ALEXANDER (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:ALTSHULER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 REISTERSTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-585-0055
Mailing Address - Fax:410-585-0222
Practice Address - Street 1:6404 REISTERSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-585-0055
Practice Address - Fax:410-585-0222
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046045-1183500000X
MD18943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist