Provider Demographics
NPI:1699376434
Name:CLEARY, MARY KATE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY KATE
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 LOCH RAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8305
Mailing Address - Country:US
Mailing Address - Phone:410-821-6611
Mailing Address - Fax:844-411-6327
Practice Address - Street 1:8100 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8305
Practice Address - Country:US
Practice Address - Phone:410-821-6611
Practice Address - Fax:844-411-6327
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist