1053550277 NPI number — JOHNS HOPKINS OUTPATIENT PHARMACY AT HOWARD COUNTRY

Table of content: (NPI 1053550277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053550277 NPI number — JOHNS HOPKINS OUTPATIENT PHARMACY AT HOWARD COUNTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNS HOPKINS OUTPATIENT PHARMACY AT HOWARD COUNTRY
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:
Provider Other Organization Name Type Code:
6
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:
1053550277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 418243
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-8243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-546-1000
Provider Business Mailing Address Fax Number:
443-546-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10710 CHARTER DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-546-1000
Provider Business Practice Location Address Fax Number:
443-546-1009
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
VP FINANCE/CFO
Authorized Official Telephone Number:
443-997-1312

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: P06973 , 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: 7720040 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2154989 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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