1396879862 NPI number — FAIRLAND MARKET 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 1396879862 NPI number — FAIRLAND MARKET INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRLAND MARKET 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:
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:
1396879862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20636-0098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-373-5848
Provider Business Mailing Address Fax Number:
301-373-5338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40845 MERCHANTS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650-3767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-997-1849
Provider Business Practice Location Address Fax Number:
301-997-1284
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
CHERRY
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
CORPORATE SECRETARY
Authorized Official Telephone Number:
301-373-5848

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P01755 , 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: 4017153 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2118897 . This is a "NCPDP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P01755 . This is a "MD PHARMACY PERMIT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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