Provider Demographics
NPI:1942598743
Name:MACCUBBIN, DEBORAH
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:MACCUBBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 MITCHELLVILLE RD
Mailing Address - Street 2:T-1004
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3110
Mailing Address - Country:US
Mailing Address - Phone:301-352-3847
Mailing Address - Fax:301-352-3847
Practice Address - Street 1:4600 MITCHELLVILLE RD
Practice Address - Street 2:T-1004
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3110
Practice Address - Country:US
Practice Address - Phone:301-352-3847
Practice Address - Fax:301-352-3847
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist