Healthcare Provider Details

I. General information

NPI: 1326680646
Provider Name (Legal Business Name): MEDSTAR SPECIALTY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7379 WASHINGTON BLVD STE 101
ELKRIDGE MD
21075-6358
US

IV. Provider business mailing address

7379 WASHINGTON BLVD STE 101
ELKRIDGE MD
21075-6358
US

V. Phone/Fax

Practice location:
  • Phone: 410-540-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH SARACINO
Title or Position: MANAGER, CENTRAL PHARMACY SUPPORT
Credential:
Phone: 410-540-4600