1386759538 NPI number — RED RUN CORPORATION

Table of content: (NPI 1386759538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386759538 NPI number — RED RUN CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED RUN CORPORATION
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:
PHARMACY DEPOT
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:
1386759538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10075 RED RUN BLVD
Provider Second Line Business Mailing Address:
SUITE 575
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-4865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-319-0808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 BELAIR RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21213-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-276-6680
Provider Business Practice Location Address Fax Number:
410-276-8247
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
419-319-0801

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P04456 , 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)





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