Provider Demographics
NPI:1194403980
Name:MACK, NATALIE (PHARMD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MACK
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 1:25066 SALTWATER CIR
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3567
Mailing Address - Country:US
Mailing Address - Phone:717-314-1255
Mailing Address - Fax:
Practice Address - Street 1:8125 RITCHIE HWY STE L
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6925
Practice Address - Country:US
Practice Address - Phone:410-870-4545
Practice Address - Fax:410-870-8585
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist