Provider Demographics
NPI:1477022143
Name:FAYNBLUT, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:FAYNBLUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BALTIMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6162
Mailing Address - Country:US
Mailing Address - Phone:410-848-5085
Mailing Address - Fax:410-848-7932
Practice Address - Street 1:630 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6162
Practice Address - Country:US
Practice Address - Phone:410-848-5085
Practice Address - Fax:410-848-7932
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist