1215034061 NPI number — MARYBETH SNIADOWSKI COLE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215034061 NPI number — MARYBETH SNIADOWSKI COLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYBETH SNIADOWSKI COLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LYONS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215034061
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21921-5906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-398-2820
Provider Business Mailing Address Fax Number:
410-398-5173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-398-2820
Provider Business Practice Location Address Fax Number:
410-398-5173
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
MARYBETH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-398-2820

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P06009 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 442550200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2141639 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 442551100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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