Healthcare Provider Details

I. General information

NPI: 1710288360
Provider Name (Legal Business Name): BELTSVILLE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2010
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 RHODE ISLAND AVE STE F
BELTSVILLE MD
20705-2570
US

IV. Provider business mailing address

5421 TALON CT
CLARKSVILLE MD
21029-1142
US

V. Phone/Fax

Practice location:
  • Phone: 301-595-5939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAKHI DE
Title or Position: DIRECTOR / PHARMACIST IN CHARGE
Credential: RPH
Phone: 301-595-5939