Provider Demographics
NPI:1194942664
Name:PLOG, THERESA MARTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARTIN
Last Name:PLOG
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 1:305 SPRING DRIVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601
Mailing Address - Country:US
Mailing Address - Phone:410-763-9093
Mailing Address - Fax:410-820-9489
Practice Address - Street 1:SHORE HEALTH SYSTEM MEMORIAL HOSPITAL
Practice Address - Street 2:219 SOUTH WASHINGTON STREET
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-822-1000
Practice Address - Fax:410-820-9489
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16260183500000X
DEA1-0002872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist