Healthcare Provider Details

I. General information

NPI: 1548451966
Provider Name (Legal Business Name): OSLER MEDICAL PHARMACY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 OSLER DR STE 110
TOWSON MD
21204-7735
US

IV. Provider business mailing address

7600 OSLER DR STE 110
TOWSON MD
21204-7735
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-0110
  • Fax: 410-821-0222
Mailing address:
  • Phone: 410-821-0110
  • Fax: 410-821-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP04699
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2038346
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: GARY KEBEJIAN
Title or Position: PHRMD
Credential: KEBEJIAN
Phone: 410-821-0110