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NPI Code Detail

MEDICARE: JOSEPH BLAKE BOURNE III

MEDICARE:   JOSEPH BLAKE BOURNE III
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
1183500000XPharmacist29390MD

General Provider Information

NPI Number : 1821873654
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH BLAKE BOURNE III
Provider Business Mailing Address
First Line : 1801 YORK RD
Second Line :
City : LUTHERVILLE
State : MD
Zip : 21093-5119
Country : US
Telephone Number : 443-470-4050
Fax Number : 443-470-4056
Provider Business Practice Location Address
First Line : 1801 YORK RD
Second Line :
City : LUTHERVILLE
State : MD
Zip : 21093-5119
Country : US
Telephone Number : 443-470-4050
Fax Number : 443-470-4056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2023
Last Update Date : 08/29/2023

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Directions to “ JOSEPH BLAKE BOURNE III ” Practice Location

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