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General NPI Number Information
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NPI Number | 1366769184
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Entity Type | Organization
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Legal Business Name | KLC PHARMACY
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 5602 BALTIMORE NATIONAL PIKE STE 100
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City | BALTIMORE
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State | MD
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Zip | 21228-1411
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Country | US
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Telephone | 443-552-5553
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Fax | 443-955-6082
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Provider Business Mailing Address
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Address Line | 5602 BALTIMORE NATIONAL PIKE STE 100
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City | BALTIMORE
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State | MD
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Zip | 21228-1411
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Country | US
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Telephone | 443-552-5553
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Fax | 443-955-6082
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Authorized Official
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Title or Position | PRESIDENT
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Name | AJAY KHANNA
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Credential |
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Telephone | 443-552-5553
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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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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | P05519
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License Number State | MD
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