Provider Demographics
NPI:1760776157
Name:MBI, PETER T (PHARMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:MBI
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 MONTPELIER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6012
Mailing Address - Country:US
Mailing Address - Phone:240-786-6045
Mailing Address - Fax:240-786-6054
Practice Address - Street 1:7500 MONTPELIER RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-6012
Practice Address - Country:US
Practice Address - Phone:240-786-6045
Practice Address - Fax:240-786-6054
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123411835P0018X
DEA1-0002390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022848600Medicaid