Healthcare Provider Details

I. General information

NPI: 1003024670
Provider Name (Legal Business Name): UTA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7116 DARLINGTON DR
BALTIMORE MD
21234-7013
US

IV. Provider business mailing address

7116 DARLINGTON DR
BALTIMORE MD
21234-7013
US

V. Phone/Fax

Practice location:
  • Phone: 410-668-6877
  • Fax:
Mailing address:
  • Phone: 410-668-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO4577
License Number StateMD

VIII. Authorized Official

Name: MRS. MERCY NNANNA
Title or Position: PHARMACY MANAGER
Credential: BS
Phone: 410-668-6877