Healthcare Provider Details

I. General information

NPI: 1972690162
Provider Name (Legal Business Name): HEREFORD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MOUNT CARMEL RD
PARKTON MD
21120-9725
US

IV. Provider business mailing address

216 MOUNT CARMEL RD
PARKTON MD
21120-9725
US

V. Phone/Fax

Practice location:
  • Phone: 410-329-6209
  • Fax: 410-357-8002
Mailing address:
  • Phone: 410-329-6209
  • Fax: 410-357-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEITH T PFAFF
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 410-329-6209