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General NPI Number Information
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NPI Number | 1083711915
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Entity Type | Organization
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Legal Business Name | PATTERSON PARK PHARMACY INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 2245 EASTERN AVE
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City | BALTIMORE
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State | MD
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Zip | 21231-3113
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Country | US
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Telephone | 410-675-6046
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Fax | 410-563-1147
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Provider Business Mailing Address
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Address Line | 2245 EASTERN AVE
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City | BALTIMORE
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State | MD
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Zip | 21231-3113
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Country | US
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Telephone | 410-675-6046
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Fax | 410-563-1147
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | RICHARD LAM
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Credential | RPH
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Telephone | 410-675-6046
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P01066
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License Number State | MD
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