Healthcare Provider Details

I. General information

NPI: 1043571367
Provider Name (Legal Business Name): NAYOSHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 COLUMBIA 100 PKWY STE H
COLUMBIA MD
21045-2336
US

IV. Provider business mailing address

8900 COLUMBIA 100 PKWY SUITE H
COLUMBIA MD
21045-2336
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1600
  • Fax: 410-740-7116
Mailing address:
  • Phone: 410-740-1600
  • Fax: 410-740-7116

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 NumberP05694
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANUPAM BHAVSAR
Title or Position: PHARMACY MANAGER
Credential:
Phone: 410-446-5433