Healthcare Provider Details

I. General information

NPI: 1083705305
Provider Name (Legal Business Name): PTR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 MOUNTAIN RD
PASADENA MD
21122-2014
US

IV. Provider business mailing address

743 S CONKLING ST
BALTIMORE MD
21224-4302
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-6000
  • Fax: 410-360-2107
Mailing address:
  • Phone: 410-327-7252
  • Fax: 410-563-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP01305
License Number StateMD

VIII. Authorized Official

Name: MR. THOMAS PETR
Title or Position: PRESIDENT/OWNER
Credential: P.D.
Phone: 410-255-6000