1669462156 NPI number — S & R CATONSVILLE LLC

Table of content: (NPI 1669462156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669462156 NPI number — S & R CATONSVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S & R CATONSVILLE 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:
NATURECARE PHARMACY
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:
1669462156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6483 BALTIMORE NATIONAL PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-869-9833
Provider Business Mailing Address Fax Number:
410-869-9834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6483 BALTIMORE NATIONAL PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-869-9833
Provider Business Practice Location Address Fax Number:
410-869-9834
Provider Enumeration Date:
10/25/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POTLURI
Authorized Official First Name:
SYAM
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
443-823-3350

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: P02474 , 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: 001848100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2037881 . This is a "PK" identifier . This identifiers is of the category "OTHER".