1245278951 NPI number — MARYLAND PHARMACIES INC

Table of content: (NPI 1245278951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245278951 NPI number — MARYLAND PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYLAND PHARMACIES 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:
1245278951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10313 GEORGIA AVE
Provider Second Line Business Mailing Address:
SUITE # 101
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-5006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-681-5878
Provider Business Mailing Address Fax Number:
301-681-5962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10313 GEORGIA AVE
Provider Second Line Business Practice Location Address:
SUITE # 101
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-5006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-681-5878
Provider Business Practice Location Address Fax Number:
301-681-5962
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VENKATESH
Authorized Official First Name:
SEKAR
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-681-5878

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P01050 , 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: 510318500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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