MEDICARE: ANNIE'S ESTATE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	P05831	MD

General Provider Information

NPI Number	:	1538405873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNIE'S ESTATE

Provider Business Mailing Address
First Line	:	1576 MERRITT BLVD STE 12
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-2114
Country	:	US
Telephone Number	:	410-284-7979
Fax Number	:	410-284-8800

Provider Business Practice Location Address
First Line	:	1576 MERRITT BLVD STE 12
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-2114
Country	:	US
Telephone Number	:	410-284-7979
Fax Number	:	410-284-8800

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. NASAR IQBAL
Credential	:	RPH
Telephone Number	:	410-284-7979

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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Directions to “ANNIE'S ESTATE ” Practice Location

Language	Start Address	Practice Location

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