MEDICARE: CATONSVILLE PHARMACY LLC

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	P02298	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750782694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATONSVILLE PHARMACY LLC

Provider Business Mailing Address
First Line	:	6350 FREDERICK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21228-2375
Country	:	US
Telephone Number	:	410-744-5959
Fax Number	:	410-744-4810

Provider Business Practice Location Address
First Line	:	6350 FREDERICK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21228-2375
Country	:	US
Telephone Number	:	410-744-5959
Fax Number	:	410-744-4810

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NEIL LEIKACH
Credential	:
Telephone Number	:	410-744-5959

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/10/2014

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Directions to “CATONSVILLE PHARMACY LLC ” Practice Location

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