Healthcare Provider Details

I. General information

NPI: 1063870020
Provider Name (Legal Business Name): CIVIC HEALTH SERVICES 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WASHINGTON ST
CAMBRIDGE MD
21613-2627
US

IV. Provider business mailing address

337 CIVIC AVE STE 20
SALISBURY MD
21804-5231
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-0900
  • Fax: 410-228-0700
Mailing address:
  • Phone: 410-749-5900
  • Fax: 410-749-5901

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 NumberP07082
License Number StateMD

VIII. Authorized Official

Name: WAHEED AZIZ
Title or Position: PHARMACIST
Credential:
Phone: 410-430-8500