Healthcare Provider Details

I. General information

NPI: 1619913233
Provider Name (Legal Business Name): MANCHESTER DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E BALTIMORE ST SUITE #A1
TANEYTOWN MD
21787-2300
US

IV. Provider business mailing address

417 E BALTIMORE ST SUITE # A1
TANEYTOWN MD
21787-2300
US

V. Phone/Fax

Practice location:
  • Phone: 410-756-5240
  • Fax: 410-756-5243
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP03001
License Number StateMD

VIII. Authorized Official

Name: THOMAS BOLTON
Title or Position: OWNER
Credential: RPH
Phone: 410-765-5240