1679103469 NPI number — KLEINS OF ABERDEEN 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 1679103469 NPI number — KLEINS OF ABERDEEN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLEINS OF ABERDEEN 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:
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:
1679103469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 ROCK SPRING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21050-2617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-420-8224
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
949 BEARDS HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21001-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-272-3101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HENDERSON
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
410-420-8220

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 399932700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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