Provider Demographics
NPI:1154324556
Name:FORMAN, MICHAEL SCOTT (BS IN PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:FORMAN
Suffix:
Gender:M
Credentials:BS IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SECURITY BLVD
Mailing Address - Street 2:MAIL STOP: C1-22-06
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1849
Mailing Address - Country:US
Mailing Address - Phone:410-786-2666
Mailing Address - Fax:410-786-0486
Practice Address - Street 1:7500 SECURITY BLVD
Practice Address - Street 2:MAIL STOP: C1-22-06
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1849
Practice Address - Country:US
Practice Address - Phone:410-786-2666
Practice Address - Fax:410-786-0486
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19489183500000X
PARP035829R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist