Provider Demographics
NPI:1609087931
Name:VAXMONSKY, DAVID J
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:VAXMONSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1814
Mailing Address - Country:US
Mailing Address - Phone:410-208-0342
Mailing Address - Fax:410-208-3852
Practice Address - Street 1:216 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1814
Practice Address - Country:US
Practice Address - Phone:410-208-0342
Practice Address - Fax:410-208-3852
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist