Provider Demographics
NPI:1225151640
Name:CARSON, MARCUS REGINALD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:REGINALD
Last Name:CARSON
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 1:3954 BALLET WAY
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1399
Mailing Address - Country:US
Mailing Address - Phone:301-476-9527
Mailing Address - Fax:
Practice Address - Street 1:631 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1228
Practice Address - Country:US
Practice Address - Phone:410-355-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163861835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy