Healthcare Provider Details

I. General information

NPI: 1174595870
Provider Name (Legal Business Name): NORTHERN PHARMACY AND MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 HARFORD RD
BALTIMORE MD
21234-7707
US

IV. Provider business mailing address

6701 HARFORD RD
BALTIMORE MD
21234-7707
US

V. Phone/Fax

Practice location:
  • Phone: 410-254-2055
  • Fax:
Mailing address:
  • Phone: 410-254-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberP01182
License Number StateMD

VIII. Authorized Official

Name: MRS. SHANNON D LANGE
Title or Position: ASSISTANT MANAGER
Credential: CPHT
Phone: 410-254-2055