Provider Demographics
NPI:1790062289
Name:CONTI, MICHAEL P (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CONTI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 TIOGA PKWY
Mailing Address - Street 2:T-2393
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-7987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 TIOGA PKWY
Practice Address - Street 2:T-2393
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-7987
Practice Address - Country:US
Practice Address - Phone:410-369-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist