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General NPI Number Information
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NPI Number | 1104238427
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Entity Type | Organization
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Legal Business Name | INDEPENDENT DRUG IMMUNIZATION LLC
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 28 KINGSTON RD
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City | BALTIMORE
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State | MD
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Zip | 21220-4814
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Country | US
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Telephone | 410-687-1115
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Fax | 410-687-0032
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Provider Business Mailing Address
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Address Line | 28 KINGSTON RD
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City | BALTIMORE
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State | MD
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Zip | 21220-4814
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Country | US
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Telephone | 410-687-1115
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Fax | 410-687-0032
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE GARMER
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Credential |
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Telephone | 410-207-5751
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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 | P04009
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License Number State | MD
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