Provider Demographics
NPI:1871533489
Name:AGNESS, CHANEL F (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHANEL
Middle Name:F
Last Name:AGNESS
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 1:20 NORTH PINE STREET
Mailing Address - Street 2:PPS DEPARTMENT, ROOM 415
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-706-5535
Mailing Address - Fax:410-706-4725
Practice Address - Street 1:20 N PINE ST
Practice Address - Street 2:PPS DEPARTMENT, ROOM 415
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1142
Practice Address - Country:US
Practice Address - Phone:410-706-5535
Practice Address - Fax:410-706-4725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168451835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy