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General NPI Number Information
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NPI Number | 1164598538
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Entity Type | Organization
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Legal Business Name | MEDPARK PHARMACY
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2002 MEDICAL PKWY SUITE 170
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3046
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Country | US
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Telephone | 410-573-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 MEDICAL PKWY SUITE 170
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3046
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Country | US
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Telephone | 410-573-6900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT COLLIER ROBERTS
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Credential | BSP
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Telephone | 410-573-6900
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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 | P02596
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License Number State | MD
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