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General NPI Number Information
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NPI Number | 1407867641
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Entity Type | Organization
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Legal Business Name | MARYLAND GROCERY STORE COMPANY
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1305 W 7TH ST
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City | FREDERICK
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State | MD
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Zip | 21702-4102
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Country | US
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Telephone | 301-631-3828
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Fax | 440-826-9107
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Provider Business Mailing Address
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Address Line | 700 CRANBERRY WOODS DR
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City | CRANBERRY TOWNSHIP
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State | PA
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Zip | 16066-5213
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Country | US
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Telephone | 412-963-6200
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Fax |
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Authorized Official
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Title or Position | VP OF PHARMACY
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Name | MICHAEL CHAPPELL
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Credential |
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Telephone | 412-963-6200
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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 | P01878
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License Number State | MD
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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 |
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License Number State |
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