Provider Demographics
NPI:1053727925
Name:HATHAWAY, AUDREY Z (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:Z
Last Name:HATHAWAY
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 1:2002 MEDICAL PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3276
Mailing Address - Country:US
Mailing Address - Phone:410-573-6900
Mailing Address - Fax:
Practice Address - Street 1:2002 MEDICAL PKWY STE 170
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3276
Practice Address - Country:US
Practice Address - Phone:410-573-6900
Practice Address - Fax:410-573-1127
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist