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General NPI Number Information
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NPI Number | 1427098177
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Entity Type | Organization
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Legal Business Name | NUTRIVENE PHARMACY GROUP INC
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 1713 EDMONDSON AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-4346
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Country | US
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Telephone | 410-747-7320
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Fax | 410-719-7951
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Provider Business Mailing Address
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Address Line | 1713 EDMONDSON AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-4346
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Country | US
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Telephone | 410-747-7320
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Fax | 410-719-7951
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Authorized Official
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Title or Position | MANAGER
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Name | JANICE HUPPMANN
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Credential |
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Telephone | 410-474-7320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P00474
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License Number State | MD
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