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General NPI Number Information
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NPI Number | 1083184360
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Entity Type | Organization
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Legal Business Name | ERDMAN AVENUE PHARMACY
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 3109 ERDMAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21213-1719
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Country | US
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Telephone | 410-617-8742
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 E MONUMENT ST
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City | BALTIMORE
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State | MD
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Zip | 21205-2334
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Country | US
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Telephone | 443-621-9123
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLUBUNMI HANNAH OWOJUYIGBE
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Credential | PHARMACIST
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Telephone | 443-621-9123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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