1174853188 NPI number — PHARMACARE AT REISTERSTOWN LLC

Table of content: (NPI 1174853188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174853188 NPI number — PHARMACARE AT REISTERSTOWN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMACARE AT REISTERSTOWN LLC
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:
PHARMACARE DISCOUNT 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:
1174853188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2227 OLD EMMORTON RD
Provider Second Line Business Mailing Address:
SUITE 122
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21015-6187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-526-1200
Provider Business Mailing Address Fax Number:
410-526-2100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11813 1/2 REISTERSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-526-1200
Provider Business Practice Location Address Fax Number:
410-526-2100
Provider Enumeration Date:
01/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANNAPPAREDDY
Authorized Official First Name:
REDDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
443-616-6500

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P05124 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 028495500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2135122 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".