Healthcare Provider Details

I. General information

NPI: 1427098177
Provider Name (Legal Business Name): NUTRIVENE PHARMACY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 EDMONDSON AVE
CATONSVILLE MD
21228-4346
US

IV. Provider business mailing address

1713 EDMONDSON AVE
CATONSVILLE MD
21228-4346
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-7320
  • Fax: 410-719-7951
Mailing address:
  • Phone: 410-747-7320
  • Fax: 410-719-7951

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 NumberP00474
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JANICE HUPPMANN
Title or Position: MANAGER
Credential:
Phone: 410-474-7320