Provider Demographics
NPI:1639266810
Name:KIRSCH, CARL
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:KIRSCH
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 1:3117 CAPE HILL CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1152
Mailing Address - Country:US
Mailing Address - Phone:410-239-3256
Mailing Address - Fax:
Practice Address - Street 1:3117 CAPE HILL CT
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1152
Practice Address - Country:US
Practice Address - Phone:410-239-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist