Healthcare Provider Details

I. General information

NPI: 1891253902
Provider Name (Legal Business Name): JONATHAN H GELLER R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8665 PHILADELPHIA RD
BALTIMORE MD
21237-3020
US

IV. Provider business mailing address

8665 PHILADELPHIA RD
BALTIMORE MD
21237-3020
US

V. Phone/Fax

Practice location:
  • Phone: 410-574-4766
  • Fax: 844-411-6243
Mailing address:
  • Phone: 410-574-4766
  • Fax: 844-411-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10812
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: