1396069423 NPI number — MEDSTAR PHARMACIES, INC.

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 1396069423 NPI number — MEDSTAR PHARMACIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSTAR PHARMACIES, INC.
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:
MEDSTAR PHARMACY VACCINATION PROGRAM
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:
1396069423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7379 WASHINGTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKRIDGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21075-6358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-540-4492
Provider Business Mailing Address Fax Number:
410-579-8264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7379 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21075-6358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-540-4492
Provider Business Practice Location Address Fax Number:
410-579-8264
Provider Enumeration Date:
03/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SARACINO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHARMACY SERVICES MANAGER
Authorized Official Telephone Number:
410-540-4492

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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