Healthcare Provider Details

I. General information

NPI: 1255618385
Provider Name (Legal Business Name): LABIC PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 AUTOMOTIVE BOULEVARD
ELKTON MD
21921
US

IV. Provider business mailing address

108 AUTOMOTIVE BLVD
ELKTON MD
21921-6374
US

V. Phone/Fax

Practice location:
  • Phone: 443-207-0574
  • Fax:
Mailing address:
  • Phone: 443-207-0574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRP045805L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS CHRISTIANA OGUNREMI
Title or Position: CHIEF CONSULTING PHARMACIST
Credential: B.SC RPH
Phone: 443-207-0574