Provider Demographics
NPI:1477141919
Name:PACQUING, KEVIN SACATROPEZ (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SACATROPEZ
Last Name:PACQUING
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 1:7731 OLD WOODSTOCK LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6980
Mailing Address - Country:US
Mailing Address - Phone:301-312-2308
Mailing Address - Fax:
Practice Address - Street 1:1645 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6521
Practice Address - Country:US
Practice Address - Phone:410-795-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist