Provider Demographics
NPI:1629241567
Name:ANDERSON, MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2030
Mailing Address - Country:US
Mailing Address - Phone:410-768-6812
Mailing Address - Fax:410-768-6812
Practice Address - Street 1:9036 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS JUNCTION
Practice Address - State:MD
Practice Address - Zip Code:20701-1130
Practice Address - Country:US
Practice Address - Phone:443-205-3939
Practice Address - Fax:301-617-0816
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135701835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric