Healthcare Provider Details

I. General information

NPI: 1942727714
Provider Name (Legal Business Name): MEDSTAR PHARMACIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
ROSEDALE MD
21237-3901
US

IV. Provider business mailing address

7379 WASHINGTON BLVD
ELKRIDGE MD
21075-6358
US

V. Phone/Fax

Practice location:
  • Phone: 410-540-4492
  • Fax:
Mailing address:
  • Phone: 410-540-4492
  • Fax: 410-579-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH SARACINO
Title or Position: MANAGER, ADMINISTRATIVE SERVICES
Credential:
Phone: 410-540-4492