1720043581 NPI number — MEDSTAR PHARMACIES, INC.

Table of content: (NPI 1720043581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720043581 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 AT UNION MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
5
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:
1720043581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2008
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:
21075-6329
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:
201 E UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-554-2557
Provider Business Practice Location Address Fax Number:
410-554-2440
Provider Enumeration Date:
04/17/2006

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 , with the licence number:  PO2070 , 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: 2122024 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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