Healthcare Provider Details

I. General information

NPI: 1518259340
Provider Name (Legal Business Name): BALTIMORE MEDICAL SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date: 05/13/2023
Reactivation Date: 06/01/2023

III. Provider practice location address

900 S CATON AVE DEPAUL BUILDING
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

5525 EASTERN AVE STE 301
BALTIMORE MD
21224-2796
US

V. Phone/Fax

Practice location:
  • Phone: 443-703-3185
  • Fax: 443-703-3197
Mailing address:
  • Phone: 443-703-3654
  • Fax: 410-732-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAWN JACOBS
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential:
Phone: 443-703-3654