Healthcare Provider Details

I. General information

NPI: 1053404491
Provider Name (Legal Business Name): OLNEY PROFESSIONAL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 PRINCE PHILIP DR
OLNEY MD
20832-1513
US

IV. Provider business mailing address

18111 PRINCE PHILIP DR SUITE 100
OLNEY MD
20832-1513
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-9812
  • Fax: 301-774-9813
Mailing address:
  • Phone: 301-774-9812
  • Fax: 301-774-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP04031
License Number StateMD

VIII. Authorized Official

Name: HELEN YI
Title or Position: PRESIDENT
Credential: RPH
Phone: 301-774-9812