Provider Demographics
NPI:1013477173
Name:SUMLIN, BRIAN C
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:SUMLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 RIVERSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1388
Mailing Address - Country:US
Mailing Address - Phone:410-272-1810
Mailing Address - Fax:410-297-2276
Practice Address - Street 1:1321 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1388
Practice Address - Country:US
Practice Address - Phone:410-272-1810
Practice Address - Fax:410-297-2276
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD111741835P0018X
MD11174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist