Provider Demographics
NPI:1174934673
Name:CLIFTON T PERKINS HOSPITAL
Entity type:Organization
Organization Name:CLIFTON T PERKINS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKOWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-724-3167
Mailing Address - Street 1:8450 DORSEY RUN RD
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9486
Mailing Address - Country:US
Mailing Address - Phone:410-724-3168
Mailing Address - Fax:410-724-3169
Practice Address - Street 1:8450 DORSEY RUN RD
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9486
Practice Address - Country:US
Practice Address - Phone:410-724-3168
Practice Address - Fax:410-724-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP005613336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145808OtherPK