Provider Demographics
NPI:1457589822
Name:GAUDET, MARK THOMAS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:GAUDET
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GREENWOOD SHLS
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-9658
Mailing Address - Country:US
Mailing Address - Phone:410-827-7589
Mailing Address - Fax:
Practice Address - Street 1:8174 OCEAN GTWY
Practice Address - Street 2:WALGREENS 9967
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7144
Practice Address - Country:US
Practice Address - Phone:410-763-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD184131835P0018X
MA209781835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist