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General NPI Number Information
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NPI Number | 1063870020
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Entity Type | Organization
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Legal Business Name | CIVIC HEALTH SERVICES 3 LLC
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 909 WASHINGTON ST
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2627
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Country | US
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Telephone | 410-228-0900
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Fax | 410-228-0700
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Provider Business Mailing Address
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Address Line | 337 CIVIC AVE STE 20
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City | SALISBURY
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State | MD
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Zip | 21804-5231
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Country | US
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Telephone | 410-749-5900
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Fax | 410-749-5901
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Authorized Official
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Title or Position | PHARMACIST
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Name | WAHEED AZIZ
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Credential |
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Telephone | 410-430-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07082
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License Number State | MD
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