Provider Demographics
NPI:1093361008
Name:ADJETEY, MARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ADJETEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18924 MARSH HAWK LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1774
Mailing Address - Country:US
Mailing Address - Phone:240-855-1894
Mailing Address - Fax:
Practice Address - Street 1:18924 MARSH HAWK LN
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-1774
Practice Address - Country:US
Practice Address - Phone:240-855-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD256451835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist