Provider Demographics
NPI:1669085627
Name:PROCTOR, ELIZABETH KESECKER
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KESECKER
Last Name:PROCTOR
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 1:6608 E LAKERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-7004
Mailing Address - Country:US
Mailing Address - Phone:240-285-2455
Mailing Address - Fax:
Practice Address - Street 1:700 CHASE SIX BLVD
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2059
Practice Address - Country:US
Practice Address - Phone:301-432-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121621835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Single Specialty