Healthcare Provider Details

I. General information

NPI: 1891770632
Provider Name (Legal Business Name): FELDMAN'S MEDICAL CENTER PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 OLD ANNAPOLIS RD
ELLICOTT CITY MD
21042-6314
US

IV. Provider business mailing address

9501 OLD ANNAPOLIS RD
ELLICOTT CITY MD
21042-6314
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-8200
  • Fax: 410-730-8092
Mailing address:
  • Phone: 410-730-8200
  • Fax: 410-730-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP01534
License Number StateMD

VIII. Authorized Official

Name: MR. LESLIE S. FELDMAN
Title or Position: PRESIDENT
Credential: RPH
Phone: 410-730-8200