Healthcare Provider Details

I. General information

NPI: 1538585773
Provider Name (Legal Business Name): MARYLAND PHARMACY AND HOME INFUSION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 RED RUN BLVD SUITE 104 B
OWINGS MILLS MD
21117-4836
US

IV. Provider business mailing address

10085 RED RUN BLVD SUITE 104 B
OWINGS MILLS MD
21117-4836
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-8271
  • Fax: 410-363-8273
Mailing address:
  • Phone: 410-363-8271
  • Fax: 410-363-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number StateMD

VIII. Authorized Official

Name: DORINE FOBI-TAKSUI
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 410-363-8271