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General NPI Number Information
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NPI Number | 1417422734
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Entity Type | Organization
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Legal Business Name | OLD COURT LTC PHARMACY INC
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Dates
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Enumeration Date | 10/13/2018
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 8607 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4713
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Country | US
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Telephone | 410-521-9520
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Fax | 410-521-9521
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Provider Business Mailing Address
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Address Line | 8607 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-4713
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Country | US
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Telephone | 410-521-9520
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Fax | 410-521-9521
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. EMEKA NWODIM
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Credential |
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Telephone | 410-521-9520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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