Healthcare Provider Details

I. General information

NPI: 1932385515
Provider Name (Legal Business Name): WHITEMARSH PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 CAMPBELL BLVD SUITE 120
NOTTINGHAM MD
21236-5908
US

IV. Provider business mailing address

4924 CAMPBELL BLVD SUITE 120
NOTTINGHAM MD
21236-5908
US

V. Phone/Fax

Practice location:
  • Phone: 443-384-2500
  • Fax: 443-384-2525
Mailing address:
  • Phone: 443-384-2500
  • Fax: 443-384-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO4046
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPO4046
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL N SOURANIS
Title or Position: PRESIDENT
Credential: P.D.
Phone: 410-633-5050