Provider Demographics
NPI:1134605033
Name:PATINO, MAIKA ISABEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAIKA
Middle Name:ISABEL
Last Name:PATINO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OAKDENE AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2039
Mailing Address - Country:US
Mailing Address - Phone:551-206-3738
Mailing Address - Fax:
Practice Address - Street 1:600 NORTH WOLFE STREET
Practice Address - Street 2:CARNEGIE 180
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-4891
Practice Address - Fax:410-614-8601
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD233331835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care