Healthcare Provider Details

I. General information

NPI: 1346347275
Provider Name (Legal Business Name): MILFORD STREET PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST SUITE 401
SALISBURY MD
21804-6953
US

IV. Provider business mailing address

106 MILFORD ST SUITE 401
SALISBURY MD
21804
US

V. Phone/Fax

Practice location:
  • Phone: 410-860-0700
  • Fax: 410-860-0079
Mailing address:
  • Phone: 410-860-0700
  • Fax: 410-860-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SANJAY L RAYATHATHA
Title or Position: MEMBER/OWNER
Credential:
Phone: 410-860-0700