Provider Demographics
NPI:1154039949
Name:MCCLUSKEY WIRTZ, MORGAN ALICIA (PHARMD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ALICIA
Last Name:MCCLUSKEY WIRTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:ALICIA
Other - Last Name:WIRTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4826 AMOS RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9690
Mailing Address - Country:US
Mailing Address - Phone:410-935-4414
Mailing Address - Fax:
Practice Address - Street 1:111 MOUNT CARMEL RD
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:MD
Practice Address - Zip Code:21120-9706
Practice Address - Country:US
Practice Address - Phone:410-343-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist