Collaboration Agreement No:
5396
Confirmation No:
5396_2231C0007253
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Research Facility
Facility
Headlands PharmaSite Research
Address
1314 Bedford Avenue
Pikesville
MD 21208
Is this the location where a copy of your collaboration agreement is on file? YES
A copy (paper or electronic) must be immediately available upon request by the Board.
Section 3 - Advanced Duties and Prescriptive and Dispensing Authority
1.Does this Collaboration Agreement include Advanced Duties?
NO
2. Does this Collaboration Agreement include prescriptive authority?
NO
3. Does this Collaboration Agreement include dispensing authority under a physician's active dispensing permit?
NO