Healthcare Provider Details

I. General information

NPI: 1295118263
Provider Name (Legal Business Name): FIRST CALL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N PACA ST 2ND FLOOR
BALTIMORE MD
21201-1815
US

IV. Provider business mailing address

405 N PACA ST 2ND FLOOR
BALTIMORE MD
21201-1815
US

V. Phone/Fax

Practice location:
  • Phone: 443-961-3578
  • Fax: 443-961-3583
Mailing address:
  • Phone: 443-961-3578
  • Fax: 443-961-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPW0488
License Number StateMD

VIII. Authorized Official

Name: SYAM POTLURI
Title or Position: MANAGING MEMBER
Credential:
Phone: 443-823-3350