Provider Demographics
NPI:1053696377
Name:POGUE, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:POGUE
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 1:8174 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7144
Mailing Address - Country:US
Mailing Address - Phone:410-763-6907
Mailing Address - Fax:410-763-8164
Practice Address - Street 1:8174 OCEAN GTWY
Practice Address - Street 2:
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:410-763-8164
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist