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General NPI Number Information
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NPI Number | 1417354085
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Entity Type | Organization
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Legal Business Name | JOHN WAYNE PHARMACY LLC
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 9106 PHILADELPHIA ROAD SUITE #100
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City | BALTIMORE
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State | MD
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Zip | 21237
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Country | US
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Telephone | 410-687-8113
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Fax | 410-391-3922
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Provider Business Mailing Address
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Address Line | 9106 PHILADELPHIA ROAD SUITE #100
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City | BALTIMORE
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State | MD
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Zip | 21237
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Country | US
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Telephone | 410-687-8113
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Fax | 410-391-3922
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. WAYNE D. VANWIE
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Credential | P.D.
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Telephone | 410-687-8113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | MD11499
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License Number State | MD
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