Basic Information
| Provider Information | |||||||||
| NPI: | 1194942664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLOG | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 SPRING DRIVE | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107639093 | ||||||||
| FaxNumber: | 4108209489 | ||||||||
| Practice Location | |||||||||
| Address1: | SHORE HEALTH SYSTEM MEMORIAL HOSPITAL | ||||||||
| Address2: | 219 SOUTH WASHINGTON STREET | ||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108221000 | ||||||||
| FaxNumber: | 4108209489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 16260 | MD | Y | Pharmacy Service Providers | Pharmacist | 183500000X | A1-0002872 | DE | N | Pharmacy Service Providers | Pharmacist |
No ID Information.