Provider Demographics
NPI:1548877632
Name:LOONEY, DYLAN GRAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:GRAY
Last Name:LOONEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 CORRIDOR MARKETPLACE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2378
Mailing Address - Country:US
Mailing Address - Phone:301-483-0949
Mailing Address - Fax:
Practice Address - Street 1:3343 CORRIDOR MARKETPLACE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2378
Practice Address - Country:US
Practice Address - Phone:301-483-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217270183500000X
MD27566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist