Healthcare Provider Details

I. General information

NPI: 1952624330
Provider Name (Legal Business Name): PHARMACARE AT MT CLAIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 W PRATT ST
BALTIMORE MD
21223-2665
US

IV. Provider business mailing address

2227 OLD EMMORTON RD SUITE 122
BEL AIR MD
21015-6187
US

V. Phone/Fax

Practice location:
  • Phone: 410-209-1100
  • Fax: 410-209-4500
Mailing address:
  • Phone: 410-209-1100
  • Fax: 410-209-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP05268
License Number StateMD

VIII. Authorized Official

Name: REDDY ANNAPPAREDDY
Title or Position: PHARMACIST
Credential:
Phone: 443-616-6500