Healthcare Provider Details

I. General information

NPI: 1174853188
Provider Name (Legal Business Name): PHARMACARE AT REISTERSTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11813 1/2 REISTERSTOWN RD
REISTERSTOWN MD
21136-3303
US

IV. Provider business mailing address

2227 OLD EMMORTON RD SUITE 122
BEL AIR MD
21015-6187
US

V. Phone/Fax

Practice location:
  • Phone: 410-526-1200
  • Fax: 410-526-2100
Mailing address:
  • Phone: 410-526-1200
  • Fax: 410-526-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP05124
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: REDDY ANNAPPAREDDY
Title or Position: PHARMACY MANAGER
Credential:
Phone: 443-616-6500