Healthcare Provider Details

I. General information

NPI: 1023007275
Provider Name (Legal Business Name): FRIENDSVILLE PHARMACY UPHOLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 MAPLE ST
FRIENDSVILLE MD
21531-2122
US

IV. Provider business mailing address

PO BOX 127
FRIENDSVILLE MD
21531-0127
US

V. Phone/Fax

Practice location:
  • Phone: 301-746-5881
  • Fax: 301-746-5803
Mailing address:
  • Phone: 301-746-5881
  • Fax: 301-746-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP06419
License Number StateMD

VIII. Authorized Official

Name: JENNIFER UPHOLD
Title or Position: PHARMD
Credential:
Phone: 814-483-4310