1649470220 NPI number — PARTNERS PHARMACY OF MARYLAND LLC

Table of content: (NPI 1649470220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649470220 NPI number — PARTNERS PHARMACY OF MARYLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS PHARMACY OF MARYLAND 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:
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:
1649470220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8910 ROUTE 108
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-2151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-910-9260
Provider Business Mailing Address Fax Number:
410-740-0146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8910 ROUTE 108
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-910-9260
Provider Business Practice Location Address Fax Number:
410-740-0146
Provider Enumeration Date:
07/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FENELON
Authorized Official First Name:
JODY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT OF COMPLIANCE
Authorized Official Telephone Number:
815-985-4873

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , with the licence number:  PW0304 , 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: 2133510 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1649470220 . This is a "NPPES" identifier . This identifiers is of the category "OTHER".




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