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General NPI Number Information
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NPI Number | 1093004533
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Entity Type | Organization
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Legal Business Name | PEMBERTON APOTHECARY, LLC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 1306 S SALISBURY BLVD UNITS 9&10
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City | SALISBURY
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State | MD
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Zip | 21801-6841
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Country | US
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Telephone | 410-677-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 1147 PEMBERTON DR
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City | SALISBURY
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State | MD
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Zip | 21801-2529
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Country | US
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Telephone | 410-677-0707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG ALLEN SCHURY
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Credential | RPH
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Telephone | 410-677-0707
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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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