Provider Demographics
NPI:1679849954
Name:CRAMER, MARY SUSAN (CPHT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:CRAMER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:M
Other - Middle Name:SUE
Other - Last Name:CRAMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:449 COUNTRY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8522
Mailing Address - Country:US
Mailing Address - Phone:443-540-4182
Mailing Address - Fax:
Practice Address - Street 1:449 COUNTRY RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8522
Practice Address - Country:US
Practice Address - Phone:443-540-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
390101070259499OtherPTCB CERTIFICATION NUMBER
MDT00930OtherSTATE REGISTRATION