Provider Demographics
NPI:1538758214
Name:MCHETZ, EDIMA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:EDIMA
Middle Name:
Last Name:MCHETZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BLACKBIRD HILL LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-5966
Mailing Address - Country:US
Mailing Address - Phone:301-957-5663
Mailing Address - Fax:
Practice Address - Street 1:118 BLACKBIRD HILL LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-5966
Practice Address - Country:US
Practice Address - Phone:301-957-5663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15387582143336I0012X
MD276643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy